{
"Npi": {
"NPI": "1013058262",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COSGRAVE PHARMACY INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "908 1ST AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SILVIS",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61282-1047",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "309-792-9527",
"MailingAddressFaxNumber": "309-792-9457",
"FirstLinePracticeLocationAddress": "908 1ST AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SILVIS",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "61282-1047",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "309-792-9527",
"PracticeLocationAddressFaxNumber": "309-792-9457",
"EnumerationDate": "02/09/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GARNER",
"AuthorizedOfficialFirstName": "PAUL",
"AuthorizedOfficialMiddleName": "H",
"AuthorizedOfficialTitle": "CORPORATE SECRETARY",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "R.PH.",
"AuthorizedOfficialTelephoneNumber": "309-792-9527",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}