{
"Npi": {
"NPI": "1437690567",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GLEASON PHARMACY SERVICES 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": "214 ABE LINCOLN DR UNIT 2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ATHENS",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62613-7800",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "217-891-1449",
"MailingAddressFaxNumber": "217-632-2033",
"FirstLinePracticeLocationAddress": "214 ABE LINCOLN DR UNIT 2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ATHENS",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62613-7800",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "217-952-7030",
"PracticeLocationAddressFaxNumber": "217-952-7031",
"EnumerationDate": "03/08/2017",
"LastUpdateDate": "06/07/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GLEASON",
"AuthorizedOfficialFirstName": "TIMOTHY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PRESIDENT/PIC/AO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "217-891-1449",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "054.020373",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}