{
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"NPI": "1821003476",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "18TH AVENUE DRUG STORE INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8110 18TH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BROOKLYN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11214-2201",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-232-5566",
"MailingAddressFaxNumber": "718-232-5255",
"FirstLinePracticeLocationAddress": "8110 18TH AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BROOKLYN",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11214-2201",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-232-5566",
"PracticeLocationAddressFaxNumber": "718-232-5255",
"EnumerationDate": "07/30/2006",
"LastUpdateDate": "03/01/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLUSTIN",
"AuthorizedOfficialFirstName": "MARAT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/SEC",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "917-922-3204",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "027708",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}