MEDICARE: PHARMACY4HUMANITY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WD0400X	Diabetes Educator Registered Nurse
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHY45310	CA
4	3336S0011X	Specialty 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
2	1997946	OTHER		PK

General Provider Information

NPI Number	:	1548269533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY4HUMANITY

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	:	120 UNIVERSITY AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3007
Country	:	US
Telephone Number	:	619-260-1010
Fax Number	:	619-260-1031

Authorized Official
Title or Position	:	CHIEF OF PHARMACY
Name	:	KENNETH SCOTT CARRUTHERS
Credential	:
Telephone Number	:	323-860-5366

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	12/03/2025

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Directions to “PHARMACY4HUMANITY ” Practice Location

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