Basic Information
| Provider Information | |||||||||
| NPI: | 1013253806 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AIDS HEALTHCARE FOUNDATION | ||||||||
| LastName: | |||||||||
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| MiddleName: | |||||||||
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| OtherOrganizationName: | AHF PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 19300 S HAMILTON AVE STE 110-111 | ||||||||
| Address2: | |||||||||
| City: | GARDENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902484400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238605241 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1230 N HIGH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432012466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142912670 | ||||||||
| FaxNumber: | 6142913473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2012 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CARRUTHERS | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SR.MGR/CHIEF PHARMACY OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3238605266 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | 022243650 | OH | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336C0003X | 1547-43 | WI | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336C0003X | 054.019491 | IL | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336C0003X | 64001951A | IN | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336S0011X | Y | Suppliers | Pharmacy | Specialty Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 2138287 | 01 | PK | OTHER | 0091847 | 05 | OH | MEDICAID |