{
"Npi": {
"NPI": "1710908777",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRESCRIPTION SHOP 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": "PO BOX 4638",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRIDGEPORT",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "26330-4638",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-842-3763",
"MailingAddressFaxNumber": "304-842-7648",
"FirstLinePracticeLocationAddress": "1212 JOHNSON AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BRIDGEPORT",
"PracticeLocationAddressStateName": "WV",
"PracticeLocationAddressPostalCode": "26330-1354",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-842-3763",
"PracticeLocationAddressFaxNumber": "304-842-7648",
"EnumerationDate": "07/22/2006",
"LastUpdateDate": "04/05/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STARKEY",
"AuthorizedOfficialFirstName": "ADAM",
"AuthorizedOfficialMiddleName": "JOSEPH",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "304-842-3763",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "SP0552384",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}