{
"Npi": {
"NPI": "1104099977",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KING KULLEN PHARMACIES CORP",
"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": "185 CENTRAL AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BETHPAGE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11714",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-733-7196",
"MailingAddressFaxNumber": "516-827-8263",
"FirstLinePracticeLocationAddress": "2660 HYLAN BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STATEN ISLAND",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10306",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-979-1005",
"PracticeLocationAddressFaxNumber": "718-980-5512",
"EnumerationDate": "04/11/2008",
"LastUpdateDate": "12/30/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KENNEDY",
"AuthorizedOfficialFirstName": "J",
"AuthorizedOfficialMiddleName": "DONALD",
"AuthorizedOfficialTitle": "TREASURER DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "516-733-7147",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "028810",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}