Provider Demographics
NPI:1013253806
Name:PHARMACY4HUMANITY
Entity Type:Organization
Organization Name:PHARMACY4HUMANITY
Other - Org Name:AHF PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRUTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-860-5366
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:323-860-5366
Mailing Address - Fax:888-877-8455
Practice Address - Street 1:1230 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2466
Practice Address - Country:US
Practice Address - Phone:614-291-2670
Practice Address - Fax:614-291-3473
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AIDS HEALTHCARE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-24
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0222436503336C0003X
WI1547-433336C0003X
IL054.0194913336C0003X
IN64001951A3336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0091847Medicaid
FP3765659OtherDRUG ENFORCEMENT ADMINISTRATION
OH022243650OtherSTATE LICENSE
2138287OtherPK