{
"Npi": {
"NPI": "1184714230",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RUSSELL FORK PHARMACIES, 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": "PO BOX 99",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAYSI",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24256-0099",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "276-865-5560",
"MailingAddressFaxNumber": "276-865-5310",
"FirstLinePracticeLocationAddress": "164 HAYSI MAIN STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HAYSI",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24256",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "276-865-5560",
"PracticeLocationAddressFaxNumber": "276-865-5310",
"EnumerationDate": "10/12/2006",
"LastUpdateDate": "06/28/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COUNTS",
"AuthorizedOfficialFirstName": "ERVIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "276-865-5560",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "0201003911",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}