Provider Demographics
NPI:1194800482
Name:PHARMACY4HUMANITY
Entity type:Organization
Organization Name:PHARMACY4HUMANITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:2097 WILTON DR
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-2121
Practice Address - Country:US
Practice Address - Phone:954-318-6997
Practice Address - Fax:954-318-6998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AIDS HEALTHCARE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-26
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2007842OtherPK
FLPH34833OtherPHARMACY LICENSE
FL031788800Medicaid
1022792OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL000985700Medicare PIN