{
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"EIN": null,
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"OtherCredential": "BS PHARMACY",
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"FirstLineMailingAddress": "55 WILLEY AVE",
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"MailingAddressCityName": "LIBERTY",
"MailingAddressStateName": "NY",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "845-292-5020",
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"FirstLinePracticeLocationAddress": "267 N MAIN ST",
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"PracticeLocationAddressCityName": "LIBERTY",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/29/2010",
"LastUpdateDate": "01/29/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"LicenseNumber": "040408",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}