{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EAST MARIETTA DRUG COMPANY, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8612 MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WOODSTOCK",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30188-4829",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-285-0760",
"MailingAddressFaxNumber": "770-971-0315",
"FirstLinePracticeLocationAddress": "1480 ROSWELL RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MARIETTA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30062-3670",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-973-7600",
"PracticeLocationAddressFaxNumber": "770-973-3032",
"EnumerationDate": "04/06/2018",
"LastUpdateDate": "04/06/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARQUESS",
"AuthorizedOfficialFirstName": "JONATHAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "770-973-7600",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}