{
"Npi": {
"NPI": "1184792871",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GRANNICK 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": "277 GREENWICH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GREENWICH",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06830-6503",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-869-3492",
"MailingAddressFaxNumber": "203-625-5590",
"FirstLinePracticeLocationAddress": "277 GREENWICH AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GREENWICH",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06830-6503",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-869-3492",
"PracticeLocationAddressFaxNumber": "203-625-5590",
"EnumerationDate": "12/01/2006",
"LastUpdateDate": "01/14/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRANNICK",
"AuthorizedOfficialFirstName": "EVAN",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "203-869-3492",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "728",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}