{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EASTSIDE PHARMACY, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "400 E PINE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "POPLAR BLUFF",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63901-5401",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "573-686-7238",
"MailingAddressFaxNumber": "573-686-7239",
"FirstLinePracticeLocationAddress": "400 E PINE ST",
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"PracticeLocationAddressCityName": "POPLAR BLUFF",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "573-686-7238",
"PracticeLocationAddressFaxNumber": "573-686-7239",
"EnumerationDate": "05/20/2006",
"LastUpdateDate": "03/26/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROWLAND",
"AuthorizedOfficialFirstName": "STEPHEN",
"AuthorizedOfficialMiddleName": "KENNEDY",
"AuthorizedOfficialTitle": "PHARMACIST/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "573-686-7238",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "621773506",
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"PrimaryTaxonomySwitch": "N"
},
{
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},
{
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"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "5573",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}