{
"Npi": {
"NPI": "1144734054",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "BEECHMONT PHARMACY, INC.",
"ParentOrgTIN": null,
"OrgName": "BEECHMONT PHARMACY, 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": "3403 MARYCREST DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OWENSBORO",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "42301-6073",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "270-314-5440",
"MailingAddressFaxNumber": "270-240-4248",
"FirstLinePracticeLocationAddress": "2025 W EVERLY BROTHERS BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "POWDERLY",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "42367-5401",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "270-377-0123",
"PracticeLocationAddressFaxNumber": "270-377-0126",
"EnumerationDate": "11/30/2017",
"LastUpdateDate": "03/07/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ELLIOTT",
"AuthorizedOfficialFirstName": "THERESA",
"AuthorizedOfficialMiddleName": "POWERS",
"AuthorizedOfficialTitle": "CPA/ACCOUNTANT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CPA",
"AuthorizedOfficialTelephoneNumber": "270-684-3414",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0002X",
"TaxonomyName": "Clinic Pharmacy",
"LicenseNumber": "P07836",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}