Healthcare Provider Details

I. General information

NPI: 1861949851
Provider Name (Legal Business Name): BESTCARE PHARMACY GRANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 BONITA ST STE A
GRANTS NM
87020-2234
US

IV. Provider business mailing address

1208 BONITA ST STE A
GRANTS NM
87020-2234
US

V. Phone/Fax

Practice location:
  • Phone: 505-287-4641
  • Fax: 505-287-7160
Mailing address:
  • Phone: 505-287-4641
  • Fax: 505-287-7160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH00004229
License Number StateNM

VIII. Authorized Official

Name: RANJITHA PALLAPOTHU
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 214-675-2012