{
"Npi": {
"NPI": "1497286124",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GENOA 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": "208 CHICKAMAUGA PIKE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAMPTON",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23669-1710",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "757-218-0130",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "200 MEDICAL DR",
"SecondLinePracticeLocationAddress": "SUITE 289",
"PracticeLocationAddressCityName": "HAMPTON",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23666-1763",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "757-750-1877",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/24/2017",
"LastUpdateDate": "03/24/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEWIS",
"AuthorizedOfficialFirstName": "PATRICK",
"AuthorizedOfficialMiddleName": "HOWARD",
"AuthorizedOfficialTitle": "PHARMACIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "757-218-0130",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "0202215442",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}