{
"Npi": {
"NPI": "1295828572",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BORAK, 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": "601 WATER ST S",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTHFIELD",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55057-2434",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "507-663-0344",
"MailingAddressFaxNumber": "507-663-8934",
"FirstLinePracticeLocationAddress": "601 WATER ST S",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTHFIELD",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55057-2434",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "507-663-0344",
"PracticeLocationAddressFaxNumber": "507-663-8934",
"EnumerationDate": "10/01/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ANDERSON",
"AuthorizedOfficialFirstName": "ROB",
"AuthorizedOfficialMiddleName": "F",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "R.PH",
"AuthorizedOfficialTelephoneNumber": "507-663-0344",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "260318-8",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}