{
"Npi": {
"NPI": "1669514691",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GARDEN ISLAND PHARMACY SERV, 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 1000",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KALAHEO",
"MailingAddressStateName": "HI",
"MailingAddressPostalCode": "96741-1000",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-338-0200",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "19665 KAUMUALII HIGHWAY",
"SecondLinePracticeLocationAddress": "BX 896",
"PracticeLocationAddressCityName": "WAIMEA",
"PracticeLocationAddressStateName": "HI",
"PracticeLocationAddressPostalCode": "96796-0896",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "808-338-0200",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/13/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SWACKER",
"AuthorizedOfficialFirstName": "STEWART",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "R.PH.",
"AuthorizedOfficialTelephoneNumber": "808-338-0200",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHY-437",
"LicenseNumberStateCode": "HI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}