Provider Demographics
NPI: | 1417387267 |
---|---|
Name: | AIDS HEALTHCARE FOUNDATION |
Entity Type: | Organization |
Organization Name: | AIDS HEALTHCARE FOUNDATION |
Other - Org Name: | AHF PHARMACY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VICE PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PETER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | REIS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 323-860-5200 |
Mailing Address - Street 1: | 19300 S. HAMILTON AVENUE |
Mailing Address - Street 2: | SUITE #107 |
Mailing Address - City: | GARDENA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90248-4411 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 310-464-8241 |
Mailing Address - Fax: | 310-771-0621 |
Practice Address - Street 1: | 19300 S. HAMILTON AVENUE |
Practice Address - Street 2: | |
Practice Address - City: | GARDENA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90248-4411 |
Practice Address - Country: | US |
Practice Address - Phone: | 310-464-8241 |
Practice Address - Fax: | 310-771-0621 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-11-14 |
Last Update Date: | 2013-11-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | PHY51042 | 333600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 333600000X | Suppliers | Pharmacy |