{
"Npi": {
"NPI": "1053963975",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MAYNARDVILLE DRUG LLC",
"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": "PO BOX 990",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW TAZEWELL",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37824-0990",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "865-278-7895",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2975 MAYNARDVILLE HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MAYNARDVILLE",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37807",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "865-658-5353",
"PracticeLocationAddressFaxNumber": "865-658-5354",
"EnumerationDate": "07/11/2019",
"LastUpdateDate": "01/06/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HALFORD",
"AuthorizedOfficialFirstName": "MICHELLE",
"AuthorizedOfficialMiddleName": "SIMMONS",
"AuthorizedOfficialTitle": "OWNER/PIC",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM D.",
"AuthorizedOfficialTelephoneNumber": "865-278-7895",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}