{
"Npi": {
"NPI": "1306088240",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GRANT COUNTY DRUGS-NORTH",
"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": "24 S MAIN ST",
"SecondLineMailingAddress": "P.O. BOX 106",
"MailingAddressCityName": "DRY RIDGE",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "41035-7329",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "859-823-5271",
"MailingAddressFaxNumber": "859-428-0595",
"FirstLinePracticeLocationAddress": "375 VIOLET RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CRITTENDEN",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "41030-8535",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "859-428-3784",
"PracticeLocationAddressFaxNumber": "859-428-0595",
"EnumerationDate": "03/24/2009",
"LastUpdateDate": "05/02/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WALLACE",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "JASON",
"AuthorizedOfficialTitle": "OWNER/PHARMACIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM.D.,R.PH",
"AuthorizedOfficialTelephoneNumber": "859-823-5271",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "P07334",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}