{
"Npi": {
"NPI": "1912983461",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "MERITUS ENTERPRISES, INC",
"ParentOrgTIN": null,
"OrgName": "MERITUS ENTERPRISES, INC",
"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": "324 E ANTIETAM ST",
"SecondLineMailingAddress": "SUITE 202",
"MailingAddressCityName": "HAGERSTOWN",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21740-5754",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-766-4167",
"MailingAddressFaxNumber": "301-745-4164",
"FirstLinePracticeLocationAddress": "324 E ANTIETAM ST",
"SecondLinePracticeLocationAddress": "SUITE 202",
"PracticeLocationAddressCityName": "HAGERSTOWN",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21740-5754",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-766-4167",
"PracticeLocationAddressFaxNumber": "301-745-4164",
"EnumerationDate": "12/16/2005",
"LastUpdateDate": "03/07/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HIGGINS",
"AuthorizedOfficialFirstName": "SUSAN",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "MANAGER/PHARMACIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "301-766-4167",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "PO1492",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}