Provider Demographics
NPI:1952560724
Name:370 PHARMACY CORP
Entity Type:Organization
Organization Name:370 PHARMACY CORP
Other - Org Name:PROHEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:NOSKOV
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:212-286-8400
Mailing Address - Street 1:370 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6503
Mailing Address - Country:US
Mailing Address - Phone:212-286-8400
Mailing Address - Fax:212-286-8688
Practice Address - Street 1:370 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6503
Practice Address - Country:US
Practice Address - Phone:212-286-8400
Practice Address - Fax:212-286-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0288833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3028851Medicaid
2070583OtherPK