{
"Npi": {
"NPI": "1437241791",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MUTUAL DRUG,INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "314 WOOD AVENUE E.",
"SecondLineMailingAddress": "PO DRAWER M",
"MailingAddressCityName": "BIG STONE GAP",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24219-0210",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "276-523-1123",
"MailingAddressFaxNumber": "276-523-4534",
"FirstLinePracticeLocationAddress": "314 WOOD AVENUE E.",
"SecondLinePracticeLocationAddress": "PO DRAWER M",
"PracticeLocationAddressCityName": "BIG STONE GAP",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24219-0210",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "276-523-1123",
"PracticeLocationAddressFaxNumber": "276-523-4534",
"EnumerationDate": "09/28/2006",
"LastUpdateDate": "09/17/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARLTON",
"AuthorizedOfficialFirstName": "EDWARD",
"AuthorizedOfficialMiddleName": "ALAN",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM.D.",
"AuthorizedOfficialTelephoneNumber": "276-523-1123",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "0201000502",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}