Healthcare Provider Details

I. General information

NPI: 1275104820
Provider Name (Legal Business Name): BESTCARE MESA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 S 2ND ST
RATON NM
87740-2234
US

IV. Provider business mailing address

1279 S 2ND ST
RATON NM
87740-2234
US

V. Phone/Fax

Practice location:
  • Phone: 575-245-6372
  • Fax:
Mailing address:
  • Phone: 575-245-6372
  • Fax: 575-245-3291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ZACHARY R WAINWRIGHT
Title or Position: PIC
Credential: PHARMD
Phone: 575-245-6372