{
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"OtherCredential": null,
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"FirstLineMailingAddress": "PO BOX 247",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KINGSLEY",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49649-0247",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "114 S BROWNSON AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KINGSLEY",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49649-5103",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "231-263-7701",
"PracticeLocationAddressFaxNumber": "231-263-7925",
"EnumerationDate": "12/20/2019",
"LastUpdateDate": "12/20/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REUTHER",
"AuthorizedOfficialFirstName": "BRIAN",
"AuthorizedOfficialMiddleName": "WILLIAM",
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"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "231-263-7701",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}