{
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"FirstLineMailingAddress": "14530 14TH AVE SE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MILL CREEK",
"MailingAddressStateName": "WA",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "4727 DENVER AVENUE SOUTH",
"SecondLinePracticeLocationAddress": "C/O BARTELL DRUG COMPANY",
"PracticeLocationAddressCityName": "SEATTLE",
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"PracticeLocationAddressTelephoneNumber": "206-763-2626",
"PracticeLocationAddressFaxNumber": "206-767-1397",
"EnumerationDate": "07/07/2006",
"LastUpdateDate": "07/08/2007",
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"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PH00020051",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}