{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MILLER ROAD PHARMACY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5097 MILLER RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FLINT",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48507-1043",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "810-228-3304",
"MailingAddressFaxNumber": "810-228-3307",
"FirstLinePracticeLocationAddress": "5097 MILLER RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FLINT",
"PracticeLocationAddressStateName": "MI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "810-228-3304",
"PracticeLocationAddressFaxNumber": "810-228-3307",
"EnumerationDate": "03/31/2015",
"LastUpdateDate": "04/30/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ELTAHIR",
"AuthorizedOfficialFirstName": "ABUSUFIAN",
"AuthorizedOfficialMiddleName": "ELTAIB",
"AuthorizedOfficialTitle": "PHARMACY MANAGER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "810-228-3304",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336S0011X",
"TaxonomyName": "Specialty Pharmacy",
"LicenseNumber": "5301010651",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
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},
{
"TaxonomyCode": "3336C0003X",
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"LicenseNumber": "5301010651",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}