{
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FORK UNION PHARMACY INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 187",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORK UNION",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23055-0187",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "434-842-3288",
"MailingAddressFaxNumber": "434-842-1447",
"FirstLinePracticeLocationAddress": "4316 B JAMES MADISON HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORK UNION",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23055",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "434-842-3208",
"PracticeLocationAddressFaxNumber": "434-842-1447",
"EnumerationDate": "07/25/2006",
"LastUpdateDate": "10/04/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "YONCE",
"AuthorizedOfficialFirstName": "IVAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER AND PHARMACIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "434-842-3208",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "0201000280",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}