Provider Demographics
NPI:1932468725
Name:AIDS HEALTHCARE FOUNDATION
Entity Type:Organization
Organization Name:AIDS HEALTHCARE FOUNDATION
Other - Org Name:MOMS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NATIONAL DIRECTOR OF PHARMACY-SRMGR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CARRUTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-860-5266
Mailing Address - Street 1:6255 W. SUNSET BLVD., 21ST FLOOR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028
Mailing Address - Country:US
Mailing Address - Phone:323-860-5281
Mailing Address - Fax:323-860-5315
Practice Address - Street 1:75 AMORY STREET
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119
Practice Address - Country:US
Practice Address - Phone:617-708-3922
Practice Address - Fax:617-522-0631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy