1073853941 NPI number — VANS IGA OF DILLON INC

NPI Number: 1073853941
Health Care Provider/Practitioner: VANS IGA OF DILLON INC

NPI Number : 1073853941 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073853941",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "VANS IGA OF DILLON 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": "110 SOUTHSIDE BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DILLON",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59725-3536",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "406-988-7121",
    "MailingAddressFaxNumber": "406-683-3540",
    "FirstLinePracticeLocationAddress": "110 SOUTHSIDE BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DILLON",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59725-3536",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "406-988-7121",
    "PracticeLocationAddressFaxNumber": "406-683-3540",
    "EnumerationDate": "02/28/2013",
    "LastUpdateDate": "02/20/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "REBISH",
    "AuthorizedOfficialFirstName": "BONNIE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PIC",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "406-988-7121",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "333600000X",
          "TaxonomyName": "Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0004X",
          "TaxonomyName": "Compounding Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "PHAPHRLIC14805",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}