{
"Npi": {
"NPI": "1326353848",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FOUR RIVERS CORRECTIONAL PHARMACY",
"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": "2757 22ND ST SE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SALEM",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97302",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-378-5449",
"MailingAddressFaxNumber": "503-378-8902",
"FirstLinePracticeLocationAddress": "88 SW 3RD AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ONTARIO",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97914",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "503-986-6969",
"PracticeLocationAddressFaxNumber": "541-889-0027",
"EnumerationDate": "08/09/2010",
"LastUpdateDate": "04/17/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NUTT",
"AuthorizedOfficialFirstName": "ROB",
"AuthorizedOfficialMiddleName": "C.",
"AuthorizedOfficialTitle": "CHIEF PHARMACY OFFICER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "541-709-1958",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336I0012X",
"TaxonomyName": "Institutional Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}