Provider Demographics
NPI:1275104820
Name:BESTCARE MESA
Entity Type:Organization
Organization Name:BESTCARE MESA
Other - Org Name:MESA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WAINWRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:575-245-6372
Mailing Address - Street 1:1279 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-2234
Mailing Address - Country:US
Mailing Address - Phone:575-245-6372
Mailing Address - Fax:575-245-3291
Practice Address - Street 1:1279 S 2ND ST
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-2234
Practice Address - Country:US
Practice Address - Phone:575-245-6372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPH00005217OtherPHARMACY LICENSE
NM52024300Medicaid