{
"Npi": {
"NPI": "1205232881",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "STOCKMAN'S SUPPLY, LLC",
"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 921",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STARKVILLE",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39760-0921",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "662-320-6836",
"MailingAddressFaxNumber": "662-320-6974",
"FirstLinePracticeLocationAddress": "13545 MS HIGHWAY 12 W",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STARKVILLE",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39759-6062",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "662-320-6836",
"PracticeLocationAddressFaxNumber": "662-320-6974",
"EnumerationDate": "11/10/2014",
"LastUpdateDate": "11/10/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LOCHRIDGE",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": "ADAM",
"AuthorizedOfficialTitle": "PHARMACY MANAGER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM.D",
"AuthorizedOfficialTelephoneNumber": "662-320-6836",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}