{
"Npi": {
"NPI": "1427879576",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "NOTTAWASEPPI HURON BAND OF THE POTAWATOMI",
"ParentOrgTIN": null,
"OrgName": "NOTTAWASEPPI HURON BAND OF THE POTAWATOMI 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": "11177 MICHIGAN AVE E",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BATTLE CREEK",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49014-8904",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "269-578-9873",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "11177 MICHIGAN AVE E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BATTLE CREEK",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49014-8904",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "269-704-8593",
"PracticeLocationAddressFaxNumber": "269-729-5151",
"EnumerationDate": "10/22/2024",
"LastUpdateDate": "04/25/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STRAATSMA",
"AuthorizedOfficialFirstName": "ANDREW",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "BUSINESS OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "269-251-7579",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332800000X",
"TaxonomyName": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}