{
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"FirstLineMailingAddress": "102 N CENTERVILLE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STURGIS",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49091-1308",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "102 N CENTERVILLE RD",
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"PracticeLocationAddressCityName": "STURGIS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "269-651-7818",
"PracticeLocationAddressFaxNumber": "269-659-2619",
"EnumerationDate": "06/02/2021",
"LastUpdateDate": "06/02/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Pharmacy Technician",
"LicenseNumber": "5303006731",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}