Provider Demographics
NPI:1558526848
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:SR.MGR/CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRUTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-860-5266
Mailing Address - Street 1:19300 S HAMILTON AVE STE 110-111
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4400
Mailing Address - Country:US
Mailing Address - Phone:323-860-5241
Mailing Address - Fax:
Practice Address - Street 1:4300 BAYOU BLVD
Practice Address - Street 2:SUITE 17D
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-1949
Practice Address - Country:US
Practice Address - Phone:850-472-0962
Practice Address - Fax:850-472-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH234993336C0003X
MS08498/7.13336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116558OtherPK
FL000364800Medicaid