{
"Npi": {
"NPI": "1013068220",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NUCKOLLS DRUG STORES, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "407 W LAFAYETTE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOLIVAR",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38008-2651",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "731-658-2941",
"MailingAddressFaxNumber": "731-658-1758",
"FirstLinePracticeLocationAddress": "407 W LAFAYETTE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOLIVAR",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "38008-2651",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "731-658-2941",
"PracticeLocationAddressFaxNumber": "731-658-1758",
"EnumerationDate": "01/15/2007",
"LastUpdateDate": "02/14/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BAIRD",
"AuthorizedOfficialFirstName": "FREEMAN",
"AuthorizedOfficialMiddleName": "HUNTER",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BS",
"AuthorizedOfficialTelephoneNumber": "731-658-2941",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "1253",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}