{
"Npi": {
"NPI": "1124467402",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COTTONWOOD DRUGS 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 130",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COTTONWOOD",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "36320-0130",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "334-691-3784",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "12890 COTTONWOOD RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COTTONWOOD",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "36320-4293",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "334-691-3784",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/19/2013",
"LastUpdateDate": "03/31/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FOLSOM",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": "RYAN",
"AuthorizedOfficialTitle": "OWNER/PHARMACIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "334-691-3784",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "114137",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}