{
"Npi": {
"NPI": "1386949550",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DJK 36 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 250",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MONTEZUMA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31063-0250",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "478-472-7561",
"MailingAddressFaxNumber": "478-472-5887",
"FirstLinePracticeLocationAddress": "112 S DOOLY ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MONTEZUMA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31063-1604",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "478-472-7561",
"PracticeLocationAddressFaxNumber": "478-472-5887",
"EnumerationDate": "01/20/2011",
"LastUpdateDate": "05/09/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KISER",
"AuthorizedOfficialFirstName": "DANIEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACIST IN CHARGE/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "478-472-7561",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHRE003393",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}