{
"Npi": {
"NPI": "1053702118",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GIDEON PHARMACY 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": "2001 INDEPENDENCE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CAPE GIRARDEAU",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63703-5805",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "573-448-3333",
"MailingAddressFaxNumber": "573-448-3335",
"FirstLinePracticeLocationAddress": "111 MAIN STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GIDEON",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63848",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "573-448-3333",
"PracticeLocationAddressFaxNumber": "573-448-3335",
"EnumerationDate": "02/11/2015",
"LastUpdateDate": "05/17/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FUNK",
"AuthorizedOfficialFirstName": "ABRAHAM",
"AuthorizedOfficialMiddleName": "T",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "573-334-1300",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}