{
"Npi": {
"NPI": "1922361138",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MEDIZINE MAN 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": "13802 DEXTER WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "THORNTON",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80602-9626",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "970-640-7698",
"MailingAddressFaxNumber": "303-955-0684",
"FirstLinePracticeLocationAddress": "1606 PRAIRIE CENTER PKWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BRIGHTON",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80601-4004",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "303-483-7455",
"PracticeLocationAddressFaxNumber": "303-483-7456",
"EnumerationDate": "06/21/2012",
"LastUpdateDate": "06/21/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GIERWATOSKI",
"AuthorizedOfficialFirstName": "THOMAS",
"AuthorizedOfficialMiddleName": "PAUL",
"AuthorizedOfficialTitle": "CEO/PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "R.PH.",
"AuthorizedOfficialTelephoneNumber": "970-640-7698",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}