=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871852772
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHARMACY4HUMANITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2012
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 619 MAIN ST
-----------------------------------------------------
City | FARMINGDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11735-4100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-547-6520
-----------------------------------------------------
Fax | 631-249-5865
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18421 S MAIN ST
-----------------------------------------------------
City | GARDENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90248-4609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-999-6089
-----------------------------------------------------
Fax | 833-261-3712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OF PHARMACY
-----------------------------------------------------
Name | KENNETH SCOTT CARRUTHERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-860-5366
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 28RO00093800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | NRX 0000369
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | NP000576
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | A9-0001178
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 031438
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PCN.0002415
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------