{
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
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"ParentOrgTIN": null,
"OrgName": "ONE SOURCE PHARMACY OF BRADENTON",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6404 OLD WINTER GARDEN RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ORLANDO",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32835-1348",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "877-490-8987",
"MailingAddressFaxNumber": "877-490-8987",
"FirstLinePracticeLocationAddress": "3501 CORTEZ RD W",
"SecondLinePracticeLocationAddress": "UNIT 901B",
"PracticeLocationAddressCityName": "BRADENTON",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "877-490-8987",
"PracticeLocationAddressFaxNumber": "877-490-8987",
"EnumerationDate": "04/19/2011",
"LastUpdateDate": "04/19/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VYAS",
"AuthorizedOfficialFirstName": "INDRAJIT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/MGR",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "877-490-8987",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PH25399",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}