{
"Npi": {
"NPI": "1942453220",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RESTORE RX 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": "PO BOX 305",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRUNSWICK",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38014-0305",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "901-388-0507",
"MailingAddressFaxNumber": "901-388-0407",
"FirstLinePracticeLocationAddress": "5169 BRUNSWICK RD #305",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BRUNSWICK",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "38014",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "901-388-0507",
"PracticeLocationAddressFaxNumber": "901-388-0407",
"EnumerationDate": "10/30/2008",
"LastUpdateDate": "04/12/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RYAN",
"AuthorizedOfficialFirstName": "NATALIE",
"AuthorizedOfficialMiddleName": "MICHELLE",
"AuthorizedOfficialTitle": "GENERAL MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "855-265-8008",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336S0011X",
"TaxonomyName": "Specialty Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "4578",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}