{
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"OrgName": "SCOTT'S QUITMAN PHARMACY, LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "310 E GOODE ST",
"SecondLineMailingAddress": "ADDRESS 2",
"MailingAddressCityName": "QUITMAN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75783",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "903-763-9600",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "310 E GOODE ST",
"SecondLinePracticeLocationAddress": "STE E",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "903-763-9600",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/06/2020",
"LastUpdateDate": "06/15/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WAKEMAN",
"AuthorizedOfficialFirstName": "CRYSTAL",
"AuthorizedOfficialMiddleName": "EVETTE",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "903-763-9600",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}