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	3336C0003X	Community/Retail Pharmacy
2	3336C0002X	Clinic Pharmacy	PHY54620	CA
3	3336S0011X	Specialty Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2000606	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821012345
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	:	4940 VAN NUYS BLVD STE 200
Second Line	:	SUITE 200
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1741
Country	:	US
Telephone Number	:	818-986-2643
Fax Number	:	818-783-7781

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	12/03/2025

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Directions to “AIDS HEALTHCARE FOUNDATION ” Practice Location

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