{
"Npi": {
"NPI": "1043329824",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "E.A. MCCULLOUGH, 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": "694 S WELLS ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKE GENEVA",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53147-2106",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-248-8582",
"MailingAddressFaxNumber": "262-248-8593",
"FirstLinePracticeLocationAddress": "269 BROAD ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAKE GENEVA",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53147-1809",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-248-6226",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/29/2006",
"LastUpdateDate": "02/04/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCCULLOUGH",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": "EDWARD",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "262-248-6226",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "4700",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}