MEDICARE: AIDS HEALTHCARE FOUNDATION

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	333600000X	Pharmacy	PHY48827	CA

General Provider Information

NPI Number	:	1801226642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIDS HEALTHCARE FOUNDATION

Provider Business Mailing Address
First Line	:	19300 S. HAMILTON AVENUE
Second Line	:	SUITE 107
City	:	GARDENA
State	:	CA
Zip	:	90248-4411
Country	:	US
Telephone Number	:	310-464-8241
Fax Number	:	310-771-0621

Provider Business Practice Location Address
First Line	:	8212 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5913
Country	:	US
Telephone Number	:	323-654-0907
Fax Number	:	323-654-6264

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	PETER REIS
Credential	:
Telephone Number	:	323-860-5200

Provider Enumeration Date	:	11/14/2013
Last Update Date	:	11/14/2013

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