{
"Npi": {
"NPI": "1710898390",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PRESTON",
"FirstName": "SAMUEL",
"MiddleName": "GEORGE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "621 HATHAWAY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOSCOW",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83843-9605",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-310-2195",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1424 BROADWAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EUREKA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95501-0134",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "170-744-1190",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/14/2026",
"LastUpdateDate": "09/14/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "1981311",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "93067",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}