{
"Npi": {
"NPI": "1710256045",
"EntityType": "Organization",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TEXAS VERVE ENTERPRISES",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3517 N MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BAYTOWN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77521-4117",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "281-838-8025",
"MailingAddressFaxNumber": "281-838-8461",
"FirstLinePracticeLocationAddress": "3517 N MAIN ST",
"SecondLinePracticeLocationAddress": "SUITE 1",
"PracticeLocationAddressCityName": "BAYTOWN",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77521-4117",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "281-838-8025",
"PracticeLocationAddressFaxNumber": "281-838-8461",
"EnumerationDate": "12/15/2011",
"LastUpdateDate": "10/30/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GILBERT",
"AuthorizedOfficialFirstName": "JADA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACY MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "281-935-3109",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "27706",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}