{
"Npi": {
"NPI": "1437201704",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BOYD'S DRUG STORE,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": "101 W JEFFERSON ST",
"SecondLineMailingAddress": "BOX 662",
"MailingAddressCityName": "KOSCIUSKO",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39090-3618",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "662-289-2211",
"MailingAddressFaxNumber": "662-289-6973",
"FirstLinePracticeLocationAddress": "101 W JEFFERSON ST",
"SecondLinePracticeLocationAddress": "BOX 662",
"PracticeLocationAddressCityName": "KOSCIUSKO",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39090-3618",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "662-289-2211",
"PracticeLocationAddressFaxNumber": "662-289-6973",
"EnumerationDate": "01/17/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOYD",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": "AMZIE",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "BS PHARMACY",
"AuthorizedOfficialTelephoneNumber": "662-289-2211",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "E3663",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}