{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SPCSA PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "12602 TOEPPERWEIN RD STE 118",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LIVE OAK",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78233-3270",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "210-448-9080",
"MailingAddressFaxNumber": "210-764-1038",
"FirstLinePracticeLocationAddress": "12602 TOEPPERWEIN RD STE 118",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LIVE OAK",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78233-3270",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "210-448-9080",
"PracticeLocationAddressFaxNumber": "210-764-1038",
"EnumerationDate": "09/23/2010",
"LastUpdateDate": "08/25/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "03/14/2023",
"NPIReactivationDate": "03/27/2023",
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BAKER HICKERSON",
"AuthorizedOfficialFirstName": "CHRISTINA",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "PHARMACY DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMACIST",
"AuthorizedOfficialTelephoneNumber": "210-448-9080",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "27157",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}