{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "JACKSON FAMILY PHARMACY,LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1201 COLLEGE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JACKSON",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "36545-2406",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "251-246-1970",
"MailingAddressFaxNumber": "251-246-1963",
"FirstLinePracticeLocationAddress": "1201 COLLEGE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JACKSON",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "36545-2406",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "251-246-1970",
"PracticeLocationAddressFaxNumber": "251-246-1963",
"EnumerationDate": "08/25/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OVERTON",
"AuthorizedOfficialFirstName": "ANITA",
"AuthorizedOfficialMiddleName": "PATTON",
"AuthorizedOfficialTitle": "PHARMACIST/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "251-246-1970",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "11492",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}