{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HIGH RIDGE ROAD DRUG CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1055 HIGH RIDGE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STAMFORD",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06905-1121",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-322-7654",
"MailingAddressFaxNumber": "203-968-9868",
"FirstLinePracticeLocationAddress": "1055 HIGH RIDGE RD",
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"PracticeLocationAddressCityName": "STAMFORD",
"PracticeLocationAddressStateName": "CT",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-322-7654",
"PracticeLocationAddressFaxNumber": "203-968-9868",
"EnumerationDate": "04/13/2006",
"LastUpdateDate": "09/21/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAYO",
"AuthorizedOfficialFirstName": "PHILIP",
"AuthorizedOfficialMiddleName": "JAMES",
"AuthorizedOfficialTitle": "OWNER AND RPH",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "203-322-7654",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "677",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}