{
"Npi": {
"NPI": "1356595417",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EXPRESS RX PHARMACY, LLC.",
"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": "743 SHURLING DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MACON",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31211-1947",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "478-742-3020",
"MailingAddressFaxNumber": "478-742-3020",
"FirstLinePracticeLocationAddress": "743 SHURLING DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MACON",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31211-1947",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "478-742-3020",
"PracticeLocationAddressFaxNumber": "478-742-3020",
"EnumerationDate": "11/15/2008",
"LastUpdateDate": "06/25/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOGAN",
"AuthorizedOfficialFirstName": "BRIDGET",
"AuthorizedOfficialMiddleName": "JOYCE",
"AuthorizedOfficialTitle": "PHARMACIST IN CHARGE",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM D",
"AuthorizedOfficialTelephoneNumber": "478-742-3020",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHRE009560",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}