{
"Npi": {
"NPI": "1750803466",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BOBS' BUDGET PHARMACY",
"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 1266",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TUCUMCARI",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "88401-1266",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "575-461-1200",
"MailingAddressFaxNumber": "575-461-4189",
"FirstLinePracticeLocationAddress": "511 S 2ND ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TUCUMCARI",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "88401-2861",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "575-461-1200",
"PracticeLocationAddressFaxNumber": "575-461-4189",
"EnumerationDate": "07/13/2017",
"LastUpdateDate": "06/16/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCCLELLAND",
"AuthorizedOfficialFirstName": "BOB",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": "III",
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "575-461-1200",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "PH2392",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}