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NPI Code Detail

MEDICARE: 1070 SOUTHERN DRUG LLC

MEDICARE: 1070 SOUTHERN DRUG LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy033179NY
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497152706
Entity Type Code : Organization
Provider Name (Legal Business Name) : 1070 SOUTHERN DRUG LLC
Provider Business Mailing Address
First Line : PO BOX 740054
Second Line :
City : BRONX
State : NY
Zip : 10474-0001
Country : US
Telephone Number : 718-618-7878
Fax Number : 718-701-0226
Provider Business Practice Location Address
First Line : 1070 SOUTHERN BLVD
Second Line :
City : BRONX
State : NY
Zip : 10459-3268
Country : US
Telephone Number : 718-618-7878
Fax Number : 718-701-0226
Authorized Official
Title or Position : CEO
Name : JACOB JAMRON
Credential :
Telephone Number : 718-991-6700
Provider Enumeration Date : 12/02/2014
Last Update Date : 09/14/2025

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Directions to “1070 SOUTHERN DRUG LLC ” Practice Location

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