{
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"EIN": null,
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"OrgName": "GREAT NECK RX INC.",
"LastName": null,
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"NamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "140A MIDDLE NECK RD",
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"MailingAddressCityName": "GREAT NECK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11021-1232",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "140A MIDDLE NECK RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GREAT NECK",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-304-5648",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/07/2023",
"LastUpdateDate": "05/09/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAKSUMOV",
"AuthorizedOfficialFirstName": "BORIS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "954-736-6957",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}