{
"Npi": {
"NPI": "1285833806",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VG'S 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": "209 S ALLOY DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FENTON",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48430-3401",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "810-629-1383",
"MailingAddressFaxNumber": "810-750-1599",
"FirstLinePracticeLocationAddress": "1390 N LEROY ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FENTON",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48430-2762",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "810-629-6074",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/13/2007",
"LastUpdateDate": "11/19/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HIGGINS",
"AuthorizedOfficialFirstName": "BRYON",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "PHARMACY PRODUCT DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "810-629-1383",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "5301008666",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}