{
"Npi": {
"NPI": "1679991236",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FREDERIC PHARMACY LLC",
"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": "201 OAK ST W",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FREDERIC",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54837-8953",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "715-327-4208",
"MailingAddressFaxNumber": "715-327-4232",
"FirstLinePracticeLocationAddress": "201 OAK ST W",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FREDERIC",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54837-8953",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "715-327-4208",
"PracticeLocationAddressFaxNumber": "715-327-4232",
"EnumerationDate": "04/01/2014",
"LastUpdateDate": "09/02/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LUNDQUIST",
"AuthorizedOfficialFirstName": "ANITA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACY DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "715-483-0260",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "9306-42",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}