{
"Npi": {
"NPI": "1184653909",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RIVESVILLE COMMUNITY PHARMACY, INC.",
"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 307",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIVESVILLE",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "26588-0307",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-278-7884",
"MailingAddressFaxNumber": "304-278-7655",
"FirstLinePracticeLocationAddress": "426 MAIN ST.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIVESVILLE",
"PracticeLocationAddressStateName": "WV",
"PracticeLocationAddressPostalCode": "26588-0307",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-278-7884",
"PracticeLocationAddressFaxNumber": "304-278-7655",
"EnumerationDate": "07/02/2006",
"LastUpdateDate": "06/03/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOFFMAN",
"AuthorizedOfficialFirstName": "MARTIN",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PHARMACIST IN CHARGE--OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "SR.",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "304-278-7884",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "SP0550695",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}