{
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "15 W ASHLAND ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ANDREWS",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29510-2543",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "843-264-3291",
"MailingAddressFaxNumber": "843-264-5425",
"FirstLinePracticeLocationAddress": "15 W ASHLAND ST",
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"PracticeLocationAddressCityName": "ANDREWS",
"PracticeLocationAddressStateName": "SC",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "843-264-3291",
"PracticeLocationAddressFaxNumber": "843-264-5425",
"EnumerationDate": "12/29/2006",
"LastUpdateDate": "10/31/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LAMB",
"AuthorizedOfficialFirstName": "TROY",
"AuthorizedOfficialMiddleName": "BLAKELY",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "843-264-3291",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "14725",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}