{
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"IsOrgSubpart": "N",
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"OrgName": "MVMEDSHOP, INC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1749",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VINEYARD HAVEN",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02568-0910",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "508-693-7979",
"MailingAddressFaxNumber": "508-693-4002",
"FirstLinePracticeLocationAddress": "117 BEACH ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "VINEYARD HAVEN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "508-693-7979",
"PracticeLocationAddressFaxNumber": "508-693-4002",
"EnumerationDate": "11/15/2006",
"LastUpdateDate": "09/29/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PERZANOWSKI",
"AuthorizedOfficialFirstName": "STEVEN",
"AuthorizedOfficialMiddleName": "JAMES",
"AuthorizedOfficialTitle": "PHARMACY MANAGER/CO-OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "508-693-7979",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
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"LicenseNumber": "CS3590",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}