{
"Npi": {
"NPI": "1639583040",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MARSHALL",
"FirstName": "MARY ELLEN",
"MiddleName": "ELLEN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MARSHALL",
"OtherFirstName": "MARY",
"OtherMiddleName": "ELLEN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "RPH",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "39510 N GAVILAN PEAK PKWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ANTHEM",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85086-2777",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "623-551-1031",
"MailingAddressFaxNumber": "623-551-4924",
"FirstLinePracticeLocationAddress": "39510 N GAVILAN PEAK PKWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ANTHEM",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85086-2777",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "623-551-1031",
"PracticeLocationAddressFaxNumber": "623-551-4924",
"EnumerationDate": "06/13/2014",
"LastUpdateDate": "06/13/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "13508",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "31813",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}