{
"Npi": {
"NPI": "1710490701",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MANN",
"FirstName": "DENZEL",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PHARM.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 649",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KOTZEBUE",
"MailingAddressStateName": "AK",
"MailingAddressPostalCode": "99752-0649",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "757-254-4481",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "436 5TH AVENUE",
"SecondLinePracticeLocationAddress": "MANIILAQ HEALTH CENTER",
"PracticeLocationAddressCityName": "KOTZEBUE",
"PracticeLocationAddressStateName": "AK",
"PracticeLocationAddressPostalCode": "99752-9975",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "757-254-4481",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/13/2017",
"LastUpdateDate": "11/13/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "0202209522",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}