{
"Npi": {
"NPI": "1558427468",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HOSPITAL PHARMACY OF MOULTRIE 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": "PO BOX 861",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOULTRIE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31776-0861",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "229-985-9296",
"MailingAddressFaxNumber": "229-891-3771",
"FirstLinePracticeLocationAddress": "203 31ST AVE SE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MOULTRIE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31768-6703",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "229-985-9296",
"PracticeLocationAddressFaxNumber": "229-985-3771",
"EnumerationDate": "12/28/2006",
"LastUpdateDate": "10/06/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "YARBROUGH",
"AuthorizedOfficialFirstName": "GREGORY",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "R.PH.",
"AuthorizedOfficialTelephoneNumber": "229-985-9296",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "4738",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}