{
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"EIN": null,
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"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "PHARM D",
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"FirstLineMailingAddress": "115 LAFAYETTE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOUNDSVILLE",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "26041-1028",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-845-0390",
"MailingAddressFaxNumber": "304-845-0391",
"FirstLinePracticeLocationAddress": "115 LAFAYETTE AVE",
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"PracticeLocationAddressCityName": "MOUNDSVILLE",
"PracticeLocationAddressStateName": "WV",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-845-0390",
"PracticeLocationAddressFaxNumber": "304-845-0391",
"EnumerationDate": "03/01/2009",
"LastUpdateDate": "03/01/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Pharmacist",
"LicenseNumber": "WV7019",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}