{
"Npi": {
"NPI": "1528141736",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUPER D DISCOUNT DRUGS",
"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": "855 WAYNE RD",
"SecondLineMailingAddress": "SUITE A-2",
"MailingAddressCityName": "SAVANNAH",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38372-1527",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "731-925-4932",
"MailingAddressFaxNumber": "731-926-2240",
"FirstLinePracticeLocationAddress": "855 WAYNE RD",
"SecondLinePracticeLocationAddress": "SUITE A-2",
"PracticeLocationAddressCityName": "SAVANNAH",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "38372-1527",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "731-925-4932",
"PracticeLocationAddressFaxNumber": "731-926-2240",
"EnumerationDate": "10/23/2006",
"LastUpdateDate": "11/15/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHUTT",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "EUGENE",
"AuthorizedOfficialTitle": "OWNER/PHARMACIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.PH.",
"AuthorizedOfficialTelephoneNumber": "731-925-4932",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "1428",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}