Healthcare Provider Details

I. General information

NPI: 1831637636
Provider Name (Legal Business Name): BESTCARE PHARMACY SPRINGER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 MAXWELL AVE #B
SPRINGER NM
87747
US

IV. Provider business mailing address

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-4729
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-2030
  • Fax: 505-214-5144
Mailing address:
  • Phone: 505-268-2030
  • Fax: 505-214-5144

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 NumberPH00004337
License Number StateNM

VIII. Authorized Official

Name: RANJITHA PALLAPOTHU
Title or Position: OWNER
Credential:
Phone: 505-268-2030