{
"Npi": {
"NPI": "1902050115",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BRIDGE STREET PHARMACY, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "817 N BRIDGE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ELKIN",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28621-3008",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-835-3131",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "817 N BRIDGE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ELKIN",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28621-3008",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "336-835-3131",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/14/2008",
"LastUpdateDate": "11/14/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RIPLEY",
"AuthorizedOfficialFirstName": "ADAM",
"AuthorizedOfficialMiddleName": "GORDON",
"AuthorizedOfficialTitle": "VICE PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD, RPH",
"AuthorizedOfficialTelephoneNumber": "336-835-3131",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "07272",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}