{
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"FirstLinePracticeLocationAddress": "14 DEPOT SQ STE 1",
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"EnumerationDate": "11/17/2025",
"LastUpdateDate": "11/17/2025",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "MAXWELL",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Long Term Care Pharmacy",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}