{
"Npi": {
"NPI": "1689964272",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HANCOCK PHARMACY AT LONG WHARF 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": "1 LONG WHARF DR",
"SecondLineMailingAddress": "SUITE 116",
"MailingAddressCityName": "NEW HAVEN",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06511-5991",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-235-6323",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1 LONG WHARF DR STE 116",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEW HAVEN",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06511-5991",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-235-6323",
"PracticeLocationAddressFaxNumber": "203-776-0240",
"EnumerationDate": "04/15/2011",
"LastUpdateDate": "03/16/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HANCOCK",
"AuthorizedOfficialFirstName": "GREGORY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "203-235-6323",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PCY.0002211",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}