{
"Npi": {
"NPI": "1710008198",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GLENN R BONIFIELD JR",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 280",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BELLS",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38006-0280",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "731-663-2077",
"MailingAddressFaxNumber": "731-663-2077",
"FirstLinePracticeLocationAddress": "131 E MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BELLS",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "38006-4167",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "731-663-2077",
"PracticeLocationAddressFaxNumber": "731-663-2077",
"EnumerationDate": "04/03/2007",
"LastUpdateDate": "02/03/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BONIFIELD",
"AuthorizedOfficialFirstName": "GLENN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPH",
"AuthorizedOfficialTelephoneNumber": "731-663-2077",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "00000120",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}