{
"Npi": {
"NPI": "1902116338",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GEVENOSKY",
"FirstName": "JASON",
"MiddleName": "ROMAN",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "PHARMD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "150 TWIN OAKS DRIVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHADY SPRING",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "25918",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-763-3593",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2987 ROBERT C BYRD DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BECKLEY",
"PracticeLocationAddressStateName": "WV",
"PracticeLocationAddressPostalCode": "25801-4400",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-252-6331",
"PracticeLocationAddressFaxNumber": "304-252-0075",
"EnumerationDate": "10/19/2010",
"LastUpdateDate": "10/29/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "RP0006766",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}