{
"Npi": {
"NPI": "1235110644",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MEDIC PHARMACY INC OF EL DORADO",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "347 W OAK STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EL DORADO",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "71730-4521",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "870-862-4931",
"MailingAddressFaxNumber": "870-862-6659",
"FirstLinePracticeLocationAddress": "347 W OAK STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EL DORADO",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "71730-4521",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "870-862-4931",
"PracticeLocationAddressFaxNumber": "870-862-6659",
"EnumerationDate": "11/11/2005",
"LastUpdateDate": "06/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HANRY",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "RICHARD",
"AuthorizedOfficialTitle": "PHARMACIST/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "870-862-4931",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "4623060001",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}