{
"Npi": {
"NPI": "1912293770",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CRT PHARMACY",
"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": "1260 S MILLEDGE AVE",
"SecondLineMailingAddress": "STE F-1",
"MailingAddressCityName": "ATHENS",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30605",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "706-543-7386",
"MailingAddressFaxNumber": "706-543-8544",
"FirstLinePracticeLocationAddress": "1260 S MILLEDGE AVE",
"SecondLinePracticeLocationAddress": "STE F-1",
"PracticeLocationAddressCityName": "ATHENS",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30605-1496",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "706-543-7386",
"PracticeLocationAddressFaxNumber": "706-543-8544",
"EnumerationDate": "06/21/2011",
"LastUpdateDate": "07/03/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NEVES",
"AuthorizedOfficialFirstName": "RABUN",
"AuthorizedOfficialMiddleName": "WILEY",
"AuthorizedOfficialTitle": "VICE PRESIDENT/PIC/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "706-543-7386",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHRE000062",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}