{
"Npi": {
"NPI": "1295879369",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MADISON AVENUE PHARMACY",
"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": "640 N FOUNTAIN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SPRINGFIELD",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45504-2202",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "937-323-1841",
"MailingAddressFaxNumber": "937-323-1016",
"FirstLinePracticeLocationAddress": "640 N FOUNTAIN AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SPRINGFIELD",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45504-2202",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "937-323-1841",
"PracticeLocationAddressFaxNumber": "937-323-1016",
"EnumerationDate": "02/20/2007",
"LastUpdateDate": "08/13/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HENNIG",
"AuthorizedOfficialFirstName": "GINGER",
"AuthorizedOfficialMiddleName": "LYNNETTE",
"AuthorizedOfficialTitle": "PEDORTHIST",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "L.PED.",
"AuthorizedOfficialTelephoneNumber": "937-788-2402",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "LPED110",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}