{
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"FirstLineMailingAddress": "PO BOX 9830",
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"MailingAddressCityName": "SALT LAKE CITY",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84109-9830",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "800-973-1955",
"MailingAddressFaxNumber": "317-575-6195",
"FirstLinePracticeLocationAddress": "9995 W 69TH ST",
"SecondLinePracticeLocationAddress": "STE 102",
"PracticeLocationAddressCityName": "EDEN PRAIRIE",
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"PracticeLocationAddressTelephoneNumber": "952-656-5095",
"PracticeLocationAddressFaxNumber": "952-656-5096",
"EnumerationDate": "03/07/2007",
"LastUpdateDate": "07/01/2011",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MIDDENDORF",
"AuthorizedOfficialFirstName": "MATTHEW",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "317-569-8234",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Pharmacist",
"LicenseNumber": "262983",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}