{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "613 UPTOWN BLVD STE 105",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CEDAR HILL",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75104-3512",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "469-575-0034",
"MailingAddressFaxNumber": "469-214-4911",
"FirstLinePracticeLocationAddress": "613 UPTOWN BLVD STE 105",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CEDAR HILL",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "469-575-0034",
"PracticeLocationAddressFaxNumber": "682-888-1593",
"EnumerationDate": "10/03/2019",
"LastUpdateDate": "05/01/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LLOYD",
"AuthorizedOfficialFirstName": "CHRISTOPHER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "817-300-5225",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Compounding Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}