{
"Npi": {
"NPI": "1043350804",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COMMUNITY PHARMACY OF GRANITE FALLS, LLC",
"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": "21 FALLS AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRANITE FALLS",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28630",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "828-396-2144",
"MailingAddressFaxNumber": "828-396-9561",
"FirstLinePracticeLocationAddress": "21 FALLS AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRANITE FALLS",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28630",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "828-396-2144",
"PracticeLocationAddressFaxNumber": "828-396-9561",
"EnumerationDate": "02/08/2007",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HUFFSTETLER",
"AuthorizedOfficialFirstName": "BRYAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER & PIC",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "828-396-2144",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "02793",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "13303",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}