Provider Demographics
NPI:1104916089
Name:870 SOUTHERN DRUG CORP.
Entity type:Organization
Organization Name:870 SOUTHERN DRUG CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:POHL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:724-779-4720
Mailing Address - Street 1:40 PENNWOOD PLACE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WARRENDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15086-6526
Mailing Address - Country:US
Mailing Address - Phone:724-779-4720
Mailing Address - Fax:724-779-4721
Practice Address - Street 1:924 MYRTLE AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-7295
Practice Address - Country:US
Practice Address - Phone:718-443-6000
Practice Address - Fax:718-874-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0298773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2123798OtherPK
NY3158481Medicaid
NY03158481Medicaid