{
"Npi": {
"NPI": "1700925898",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MINTZ COASTAL DRUG STORE INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 70",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHALLOTTE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28459-0070",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "910-754-6563",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4802 MAIN STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SHALLOTTE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28470-1863",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "910-754-6563",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/05/2007",
"LastUpdateDate": "03/12/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MINTZ",
"AuthorizedOfficialFirstName": "THERESA",
"AuthorizedOfficialMiddleName": "LOU",
"AuthorizedOfficialTitle": "PRESIDENT, MANAGER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "910-754-6563",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "09293",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}