Healthcare Provider Details

I. General information

NPI: 1790137735
Provider Name (Legal Business Name): BESTCARE PHARMACY ANGEL FIRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT B4, THE INN, HIGHWAY 434
ANGEL FIRE NM
87710
US

IV. Provider business mailing address

UNIT B4, THE INN, HIGHWAY 434
ANGEL FIRE NM
87710
US

V. Phone/Fax

Practice location:
  • Phone: 575-208-1616
  • Fax:
Mailing address:
  • Phone: 575-208-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH00004273
License Number StateNM

VIII. Authorized Official

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