{
"Npi": {
"NPI": "1891088845",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROVIDENCE HEALTH & SERVICES-WA",
"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": "3305 NASSAU ST # 101",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EVERETT",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98201-4140",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "425-228-7222",
"MailingAddressFaxNumber": "425-259-7225",
"FirstLinePracticeLocationAddress": "3305 NASSAU ST # 101",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EVERETT",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98201-4140",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "425-258-7222",
"PracticeLocationAddressFaxNumber": "425-259-7225",
"EnumerationDate": "05/24/2011",
"LastUpdateDate": "05/24/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SOMERS",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": "LEON",
"AuthorizedOfficialTitle": "PHARMACIST IN CHARGE",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMACIST",
"AuthorizedOfficialTelephoneNumber": "425-258-7222",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "1835P0018X",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}