{
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"FirstLineMailingAddress": "1149 HARRISBURG PIKE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CARLISLE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17013-1607",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "717-240-5520",
"MailingAddressFaxNumber": "717-960-8371",
"FirstLinePracticeLocationAddress": "40 FURLONG DR",
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"PracticeLocationAddressCityName": "REVERE",
"PracticeLocationAddressStateName": "MA",
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"PracticeLocationAddressTelephoneNumber": "781-284-0717",
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"EnumerationDate": "10/22/2012",
"LastUpdateDate": "04/09/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHEELER",
"AuthorizedOfficialFirstName": "ROGER",
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"AuthorizedOfficialTitle": "PRESIDENT OF PHARMACY",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "207-885-2518",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}