{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "FORT MYERS BEACH PHARMACY",
"LastName": null,
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1003 8TH AVE W",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRADENTON",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34205-7709",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "941-794-2444",
"MailingAddressFaxNumber": "941-794-2446",
"FirstLinePracticeLocationAddress": "1003 8TH AVE W",
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"PracticeLocationAddressCityName": "BRADENTON",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "941-794-2444",
"PracticeLocationAddressFaxNumber": "941-794-2446",
"EnumerationDate": "01/10/2013",
"LastUpdateDate": "05/02/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PADGETT",
"AuthorizedOfficialFirstName": "ROBIN",
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"AuthorizedOfficialTitle": "PRESCRIPTION DEPARTMENT MANAGER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PH26595",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}