{
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BEACON FALLS PHARMACY, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 218",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BEACON FALLS",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06403-0218",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-729-4567",
"MailingAddressFaxNumber": "203-729-4573",
"FirstLinePracticeLocationAddress": "20 N MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BEACON FALLS",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06403-1131",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-729-4567",
"PracticeLocationAddressFaxNumber": "203-729-4573",
"EnumerationDate": "07/14/2006",
"LastUpdateDate": "01/18/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRADLEY",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "203-729-4567",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PCY2015",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}