870 Southern Drug Corp.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

029877 Issued in NY

Legal business name

870 SOUTHERN DRUG CORP.

Doing business as

Kingsboro Pharmacy

Practice address

924 Myrtle Avenue
Brooklyn, NY 11206-7295

Phone

(718) 443-6000

Fax

(718) 874-3638

NPI assigned

Oct 13, 2006

Last updated

May 4, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Joseph P Pohl III

Title

President & Ceo

Phone

(724) 779-4720

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Kingsboro Pharmacy Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Pharmedquest Pharmacy Services

  dba Avita Pharmacy 1004

  • Community/Retail Pharmacy
  • Los Angeles, CA
  • NPI 1831724244

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588550400000",
    "number": "1104916089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 PENNWOOD PLACE",
            "address_2": "SUITE 300",
            "city": "WARRENDALE",
            "state": "PA",
            "postal_code": "150866526",
            "telephone_number": "724-779-4720",
            "fax_number": "724-779-4721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "924 MYRTLE AVENUE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112067295",
            "telephone_number": "718-443-6000",
            "fax_number": "718-874-3638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "870 SOUTHERN DRUG CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2020-05-04",
        "certification_date": "2020-05-04",
        "status": "A",
        "authorized_official_last_name": "POHL",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "724-779-4720",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "029877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2123798",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3158481",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kingsboro Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kingsboro Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.