{
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"ParentOrgLBN": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "PO BOX 105",
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"MailingAddressCityName": "PERRY",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48872-0105",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "517-625-8640",
"MailingAddressFaxNumber": "517-625-8642",
"FirstLinePracticeLocationAddress": "150 S. MAIN ST",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "PERRY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "517-625-8640",
"PracticeLocationAddressFaxNumber": "517-625-8642",
"EnumerationDate": "06/23/2006",
"LastUpdateDate": "08/21/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LARNER",
"AuthorizedOfficialFirstName": "DAVID",
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"AuthorizedOfficialTitle": "MEMBER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "517-410-8581",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}