{
"Npi": {
"NPI": "1376264432",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KTM PHARMACY",
"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": "2564 E MOUNTAIN LEDGE CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ST GEORGE",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84790-5052",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "435-817-5559",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1483 E 3850 S UNIT B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ST GEORGE",
"PracticeLocationAddressStateName": "UT",
"PracticeLocationAddressPostalCode": "84790-6233",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "435-628-0842",
"PracticeLocationAddressFaxNumber": "435-628-0682",
"EnumerationDate": "09/07/2022",
"LastUpdateDate": "09/07/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JONES",
"AuthorizedOfficialFirstName": "KENNY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACIST/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "435-817-5559",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}