Provider Demographics
NPI:1588087308
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:323-860-5200
Mailing Address - Street 1:879 W 190TH ST STE 1020
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4255
Mailing Address - Country:US
Mailing Address - Phone:323-860-5366
Mailing Address - Fax:888-877-8455
Practice Address - Street 1:700 SE 3RD AVE STE 100
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1154
Practice Address - Country:US
Practice Address - Phone:954-761-4531
Practice Address - Fax:954-761-4539
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AIDS HEALTHCARE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-30
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
DCNRX00004793336C0003X
NY0327213336C0003X
WAPHNR.FO.605769253336C0003X
OHNRP022453200-033336C0003X
LAPHY007002-NR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010793700Medicaid
FLPH34811OtherPHARMACY LICENSE
2144065OtherPK