{
"Npi": {
"NPI": "1790817724",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HAZELWOOD PHARMACY INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"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": "PO BOX 247",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAZELWOOD",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28738-0247",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "429 HAZELWOOD AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HAZELWOOD",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28786-1946",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "828-456-5481",
"PracticeLocationAddressFaxNumber": "828-452-2120",
"EnumerationDate": "03/13/2007",
"LastUpdateDate": "09/12/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KEENUM JAMES",
"AuthorizedOfficialFirstName": "GERALDINE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACIST MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "828-456-5481",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "04034",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}