{
"Npi": {
"NPI": "1497302350",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BACK HOME PHARMACY 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": "2508 GRAY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HOPEWELL",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23860-5026",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "804-458-3784",
"MailingAddressFaxNumber": "804-458-6450",
"FirstLinePracticeLocationAddress": "2508 GRAY ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HOPEWELL",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23860-5026",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "804-458-3784",
"PracticeLocationAddressFaxNumber": "804-458-6450",
"EnumerationDate": "08/23/2019",
"LastUpdateDate": "04/14/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FOTIS",
"AuthorizedOfficialFirstName": "GEORGE",
"AuthorizedOfficialMiddleName": "NICHOLAS",
"AuthorizedOfficialTitle": "MEMBER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "410-961-9428",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}