{
"Npi": {
"NPI": "1871522029",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JIFFY WESTSIDE PHARMACY",
"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": "1204 W MARKET ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ATHENS",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "35611-4769",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "256-233-2307",
"MailingAddressFaxNumber": "256-233-0865",
"FirstLinePracticeLocationAddress": "1204 W MARKET ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ATHENS",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "35611-4769",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "256-233-2307",
"PracticeLocationAddressFaxNumber": "256-233-0865",
"EnumerationDate": "07/01/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MILBY",
"AuthorizedOfficialFirstName": "TERRELL",
"AuthorizedOfficialMiddleName": "G",
"AuthorizedOfficialTitle": "OWNER/VICE PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "R.PH.",
"AuthorizedOfficialTelephoneNumber": "25623323307",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "111507",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}