{
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LAST FRONTIER HEALTHCARE DISTRICT",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 190",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALTURAS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "96101-0190",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "530-708-8850",
"MailingAddressFaxNumber": "530-233-4449",
"FirstLinePracticeLocationAddress": "1111 N NAGLE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALTURAS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "96101-3840",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "530-708-8850",
"PracticeLocationAddressFaxNumber": "530-233-4449",
"EnumerationDate": "02/13/2017",
"LastUpdateDate": "10/15/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HUTCHINS",
"AuthorizedOfficialFirstName": "KENDELL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACY MANAGER/PIC/AO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "530-708-8850",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336L0003X",
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},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHE54540",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}