Healthcare Provider Details

I. General information

NPI: 1457880114
Provider Name (Legal Business Name): BESTCARE PHARMACY-MORA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#3 A033 BESTCARE PHARMACY-MORA LLC
MORA NM
87732
US

IV. Provider business mailing address

PO BOX 8156
ALBUQUERQUE NM
87198-8156
US

V. Phone/Fax

Practice location:
  • Phone: 575-387-5703
  • Fax: 505-212-0888
Mailing address:
  • Phone: 575-387-5703
  • Fax: 505-212-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00004422
License Number StateNM

VIII. Authorized Official

Name: MS. VIJAYA KALIDINDI
Title or Position: OWNER
Credential: OWNER
Phone: 575-387-5703