{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
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"LastName": null,
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"NamePrefix": null,
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"OtherLastName": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "805 E POLSTON AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "POST FALLS",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83854-6044",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-457-4112",
"MailingAddressFaxNumber": "208-457-4122",
"FirstLinePracticeLocationAddress": "15837 N WESTWOOD DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RATHDRUM",
"PracticeLocationAddressStateName": "ID",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-457-4112",
"PracticeLocationAddressFaxNumber": "208-457-4122",
"EnumerationDate": "10/31/2025",
"LastUpdateDate": "10/31/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BAKER",
"AuthorizedOfficialFirstName": "MEGAN",
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"AuthorizedOfficialTitle": "OWNER/MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "360-773-6375",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}