{
"Npi": {
"NPI": "1790795581",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NORTH FLORIDA PHARMACY, INC.",
"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": "347 SW MAIN BLVD",
"SecondLineMailingAddress": "SUITE 102",
"MailingAddressCityName": "LAKE CITY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32025-5262",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "386-758-6770",
"MailingAddressFaxNumber": "386-758-9413",
"FirstLinePracticeLocationAddress": "347 SW MAIN BLVD",
"SecondLinePracticeLocationAddress": "SUITE 102",
"PracticeLocationAddressCityName": "LAKE CITY",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32025-5262",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "386-758-6770",
"PracticeLocationAddressFaxNumber": "386-758-9413",
"EnumerationDate": "08/08/2006",
"LastUpdateDate": "11/03/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROSENFELD",
"AuthorizedOfficialFirstName": "JOEL",
"AuthorizedOfficialMiddleName": "E.",
"AuthorizedOfficialTitle": "CO-OWNER/VP/PHARMACIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "386-758-6770",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "PH12595",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PH12595",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}