Provider Demographics
NPI:1093057598
Name:AIDS HEALTH FOUNDATION
Entity Type:Organization
Organization Name:AIDS HEALTH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MIMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:310-771-0619
Mailing Address - Street 1:19300 S. HAMILTON AVENUE
Mailing Address - Street 2:STE 170
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248
Mailing Address - Country:US
Mailing Address - Phone:310-771-0619
Mailing Address - Fax:310-771-0621
Practice Address - Street 1:19300 S. HAMILTON AVE.
Practice Address - Street 2:STE 170
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248
Practice Address - Country:US
Practice Address - Phone:310-771-0619
Practice Address - Fax:310-771-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty