{
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"NPI": "1881963460",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THREE NOTCH PHARMACY LLC",
"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 129",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRAND BAY",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "36541-0129",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "251-865-1040",
"MailingAddressFaxNumber": "251-865-1041",
"FirstLinePracticeLocationAddress": "7700 THREE NOTCH RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MOBILE",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "36619-1129",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "251-661-0066",
"PracticeLocationAddressFaxNumber": "251-661-0063",
"EnumerationDate": "12/28/2011",
"LastUpdateDate": "11/13/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COTTRELL",
"AuthorizedOfficialFirstName": "CHARLES",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PHARMACIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "251-802-0387",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "113860",
"LicenseNumberStateCode": "AL",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}