{
"Npi": {
"NPI": "1679039614",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WALSH",
"FirstName": "LUCAS",
"MiddleName": "SHANE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PHARM D",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4542 NANTUCKET DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "REDDING",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "96001-5842",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "829 S MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "YREKA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "96097-3320",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "530-339-1444",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/14/2019",
"LastUpdateDate": "02/14/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "56560",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}