{
"Npi": {
"NPI": "1225238447",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HAISTEN ENTERPRISES PC",
"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": "102 E FOLSOM BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "POCOLA",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "74902-3150",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "918-436-2900",
"MailingAddressFaxNumber": "918-436-7070",
"FirstLinePracticeLocationAddress": "102 E FOLSOM BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "POCOLA",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "74902-3150",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "918-436-2900",
"PracticeLocationAddressFaxNumber": "918-436-7070",
"EnumerationDate": "07/25/2007",
"LastUpdateDate": "06/17/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HAISTEN",
"AuthorizedOfficialFirstName": "CLAY",
"AuthorizedOfficialMiddleName": "T",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "918-436-2900",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "194449",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}