Basic Information
| Provider Information | |||||||||
| NPI: | 1871852772 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AIDS HEALTHCARE FOUNDATION | ||||||||
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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 | ||||||||
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| Practice Location | |||||||||
| Address1: | 619 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FARMINGDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117354100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315476520 | ||||||||
| FaxNumber: | 6312495865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2012 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | CARRUTHERS | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF PHARMACY OFFICER/SRMGR | ||||||||
| AuthorizedOfficialTelephone: | 3238605200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | NRX 0000369 | DC | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336C0003X | NP000576 | PA | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336C0003X | A9-0001178 | DE | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336C0003X | 031438 | NY | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336C0003X | 28RO00093800 | NJ | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336C0003X | PCN.0002415 | CT | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 2136577 | 01 | PK | OTHER | 03489998 | 05 | NY | MEDICAID |