{
"Npi": {
"NPI": "1174669733",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LEROY M GODFREY",
"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": "PO BOX 287",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GARIBALDI",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97118-0287",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-322-3456",
"MailingAddressFaxNumber": "503-322-0003",
"FirstLinePracticeLocationAddress": "510 GARIBALDI AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GARIBALDI",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97118-1513",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "503-322-3456",
"PracticeLocationAddressFaxNumber": "503-322-0003",
"EnumerationDate": "01/30/2007",
"LastUpdateDate": "05/20/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GODFREY",
"AuthorizedOfficialFirstName": "LEROY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "503-322-3456",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "RP0000226",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}