{
"Npi": {
"NPI": "1770655904",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BOONE PHARMACY MANAGEMENT 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": "PO BOX 426",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JACKSON",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "36545-0426",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "251-246-2271",
"MailingAddressFaxNumber": "251-246-2277",
"FirstLinePracticeLocationAddress": "201 COMMERCE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JACKSON",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "36545-2717",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "251-246-2271",
"PracticeLocationAddressFaxNumber": "251-246-2277",
"EnumerationDate": "11/14/2006",
"LastUpdateDate": "01/06/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOONE",
"AuthorizedOfficialFirstName": "RICHARD",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "334-341-3466",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "106440",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}