{
"Npi": {
"NPI": "1386718351",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COLPHARM, INC.",
"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": "PO BOX 477",
"SecondLineMailingAddress": "538 STATE STREET",
"MailingAddressCityName": "MILLVILLE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17846-0477",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "570-458-5573",
"MailingAddressFaxNumber": "570-458-6113",
"FirstLinePracticeLocationAddress": "5 MOUNTAIN MALL",
"SecondLinePracticeLocationAddress": "SUITE 2",
"PracticeLocationAddressCityName": "SHICKSHINNY",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "18655-1227",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "570-542-2420",
"PracticeLocationAddressFaxNumber": "570-542-2396",
"EnumerationDate": "11/20/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BIRTH",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "EARLE",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PD",
"AuthorizedOfficialTelephoneNumber": "570-458-5573",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PP412844L",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}