{
"Npi": {
"NPI": "1881996114",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KERNERSVILLE PHARMACY LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "841 OLD WINSTON RD",
"SecondLineMailingAddress": "STE 90",
"MailingAddressCityName": "KERNERSVILLE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27284-7144",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-497-4511",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "841 OLD WINSTON RD",
"SecondLinePracticeLocationAddress": "STE 90",
"PracticeLocationAddressCityName": "KERNERSVILLE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27284-7144",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "336-497-4511",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/18/2010",
"LastUpdateDate": "11/18/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WATTS",
"AuthorizedOfficialFirstName": "STANLEY",
"AuthorizedOfficialMiddleName": "OAKLEY",
"AuthorizedOfficialTitle": "PHARMACIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH.",
"AuthorizedOfficialTelephoneNumber": "336-497-4511",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "10521",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}