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1316172190 NPI number — MR. HARRY LEE BROGDEN JR.

NPI Number: 1316172190
Health Care Provider/Practitioner: MR. HARRY LEE BROGDEN JR.

Information about “1316172190” NPI (MR. HARRY LEE BROGDEN JR.) exists in 1316172190 in HTML format HTML  |  1316172190 in plain Text format TXT  |  1316172190 in PDF (Portable Document Format) PDF  |  1316172190 in an XML format XML  formats.

NPI Number : 1316172190 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1316172190",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BROGDEN",
    "FirstName": "HARRY",
    "MiddleName": "LEE",
    "NamePrefix": "MR.",
    "NameSuffix": "JR.",
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4446 US HIGHWAY 220 N STE C",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SUMMERFIELD",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27358-9415",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "336-644-7058",
    "MailingAddressFaxNumber": "336-644-7297",
    "FirstLinePracticeLocationAddress": "4446 US HIGHWAY 220 N STE C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SUMMERFIELD",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27358-9415",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "336-644-7058",
    "PracticeLocationAddressFaxNumber": "336-644-7297",
    "EnumerationDate": "05/21/2009",
    "LastUpdateDate": "05/21/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "10438",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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