Provider Demographics
NPI:1225320633
Name:BEST CARE MEDICAL MANAGEMENT, INC
Entity Type:Organization
Organization Name:BEST CARE MEDICAL MANAGEMENT, INC
Other - Org Name:PACIFIC GRAND PHARMACY & SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGDASARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-548-0022
Mailing Address - Street 1:501 W GLENOAKS BLVD
Mailing Address - Street 2:12
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3395
Mailing Address - Country:US
Mailing Address - Phone:818-500-1517
Mailing Address - Fax:
Practice Address - Street 1:501 W GLENOAKS BLVD
Practice Address - Street 2:12
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3395
Practice Address - Country:US
Practice Address - Phone:818-500-1517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CAPHY441763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA441760Medicaid
CA1265670001Medicare NSC