Healthcare Provider Details

I. General information

NPI: 1063876183
Provider Name (Legal Business Name): ABQ BESTCARE PHARMACY 3 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 TRANSPORT ST SE
ALBUQUERQUE NM
87106-4382
US

IV. Provider business mailing address

PO BOX 8156
ALBUQUERQUE NM
87198-8156
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-2030
  • Fax: 505-268-2022
Mailing address:
  • Phone: 505-268-2030
  • Fax: 505-268-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00004186
License Number StateNM

VIII. Authorized Official

Name: RANJITHA PALLAPOTHU
Title or Position: MANAGER
Credential:
Phone: 917-769-8014