{
"Npi": {
"NPI": "1932642600",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GREENWOOD DRUG, 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": "2104 KIMBALL AVE STE B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WATERLOO",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "50702-5037",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "319-234-6673",
"MailingAddressFaxNumber": "319-274-9064",
"FirstLinePracticeLocationAddress": "2104 KIMBALL AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WATERLOO",
"PracticeLocationAddressStateName": "IA",
"PracticeLocationAddressPostalCode": "50702-5037",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "319-234-6673",
"PracticeLocationAddressFaxNumber": "319-226-5898",
"EnumerationDate": "11/29/2016",
"LastUpdateDate": "04/23/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GREENWOOD",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "JOHN",
"AuthorizedOfficialTitle": "PIC/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BS PHARMACY",
"AuthorizedOfficialTelephoneNumber": "319-234-6673",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "1635",
"LicenseNumberStateCode": "IA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}