MEDICARE: BESTCARE HIGHLAND LLC

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
2	3336C0003X	Community/Retail Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336C0003X	Community/Retail Pharmacy	PH00004108	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2155864	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417945494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BESTCARE HIGHLAND LLC

Provider Business Mailing Address
First Line	:	717 ENCINO PL NE
Second Line	:	STE 1
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-2611
Country	:	US
Telephone Number	:	505-243-3777
Fax Number	:	505-246-0145

Provider Business Practice Location Address
First Line	:	717 ENCINO PL NE
Second Line	:	STE 1
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-2611
Country	:	US
Telephone Number	:	505-243-3777
Fax Number	:	505-246-0145

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. ASHOK POTHULA
Credential	:
Telephone Number	:	505-243-3777

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	10/06/2023

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Directions to “BESTCARE HIGHLAND LLC ” Practice Location

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