MEDICARE: AIDS HEALTHCARE FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3336S0011X	Specialty Pharmacy
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073043204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIDS HEALTHCARE FOUNDATION

Provider Business Mailing Address
First Line	:	18421 S MAIN ST
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90248-4609
Country	:	US
Telephone Number	:	310-999-6089
Fax Number	:	833-261-3712

Provider Business Practice Location Address
First Line	:	4630 BORDER VILLAGE RD STE K
Second Line	:
City	:	SAN YSIDRO
State	:	CA
Zip	:	92173-3154
Country	:	US
Telephone Number	:	619-428-3760
Fax Number	:

Authorized Official
Title or Position	:	CHIEF PHARMACY OFFICER
Name	:	KENNETH SCOTT CARRUTHERS
Credential	:
Telephone Number	:	323-860-5200

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	11/20/2025

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Directions to “AIDS HEALTHCARE FOUNDATION ” Practice Location

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