{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "BONANZA STATE PHARMACY AND DISCOUNT CORP",
"LastName": null,
"FirstName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "19752 SW 177TH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIAMI",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33187-2600",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "19752 SW 177TH AVE",
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"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "305-378-6116",
"PracticeLocationAddressFaxNumber": "305-378-4435",
"EnumerationDate": "05/27/2008",
"LastUpdateDate": "03/20/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RAYMOND",
"AuthorizedOfficialFirstName": "JOHNNY",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialTelephoneNumber": "305-378-6116",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PH23397",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}