{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "DAVIDSON DRUG, LLC",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "489 ORR RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ASH FLAT",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72513-9705",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "870-955-1022",
"MailingAddressFaxNumber": "870-955-5052",
"FirstLinePracticeLocationAddress": "1238A HIGHWAY 62 412",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HIGHLAND",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72542-9468",
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"PracticeLocationAddressTelephoneNumber": "870-955-1022",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/16/2019",
"LastUpdateDate": "08/18/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAVIDSON",
"AuthorizedOfficialFirstName": "KEN",
"AuthorizedOfficialMiddleName": "SEARCY",
"AuthorizedOfficialTitle": "PHARMACIST/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PD",
"AuthorizedOfficialTelephoneNumber": "870-955-1022",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}