{
"Npi": {
"NPI": "1689822348",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WINN -DIXIE PHARMACY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1860 HWY 60 E",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKE WALES",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33853-4368",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "863-676-2266",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1860 HWY 60 E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAKE WALES",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33853-4368",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "863-676-2266",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/05/2008",
"LastUpdateDate": "09/05/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABRAHAM",
"AuthorizedOfficialFirstName": "STEJO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "813-684-9492",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "305S00000X",
"TaxonomyName": "Point of Service",
"LicenseNumber": "PS41329",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}