Provider Demographics
NPI:1861949851
Name:BESTCARE PHARMACY GRANTS LLC
Entity type:Organization
Organization Name:BESTCARE PHARMACY GRANTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RANJITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLAPOTHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-675-2012
Mailing Address - Street 1:1208 BONITA ST STE A
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-2234
Mailing Address - Country:US
Mailing Address - Phone:505-287-4641
Mailing Address - Fax:505-287-7160
Practice Address - Street 1:1208 BONITA ST STE A
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-2234
Practice Address - Country:US
Practice Address - Phone:505-287-4641
Practice Address - Fax:505-287-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
NMPH00004229333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159707OtherPK