{
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"EIN": null,
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"IsOrgSubpart": "Y",
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"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherOrgName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "73 SPORTSMAN DR",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "MARENGO",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "419-253-0632",
"MailingAddressFaxNumber": "419-253-0622",
"FirstLinePracticeLocationAddress": "73 SPORTSMAN DR",
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"PracticeLocationAddressTelephoneNumber": "419-253-0632",
"PracticeLocationAddressFaxNumber": "419-253-0622",
"EnumerationDate": "09/30/2016",
"LastUpdateDate": "07/31/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NEWMAN",
"AuthorizedOfficialFirstName": "NICHOLAS",
"AuthorizedOfficialMiddleName": "WILLIAM",
"AuthorizedOfficialTitle": "PHARMACIST IN CHARGE",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "419-253-0732",
"Taxonomies": {
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{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
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},
{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}