Provider Demographics
NPI:1417945494
Name:BESTCARE HIGHLAND LLC
Entity Type:Organization
Organization Name:BESTCARE HIGHLAND LLC
Other - Org Name:HIGHLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:POTHULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-243-3777
Mailing Address - Street 1:717 ENCINO PL NE
Mailing Address - Street 2:STE 1
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2611
Mailing Address - Country:US
Mailing Address - Phone:505-243-3777
Mailing Address - Fax:505-246-0145
Practice Address - Street 1:717 ENCINO PL NE
Practice Address - Street 2:STE 1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2611
Practice Address - Country:US
Practice Address - Phone:505-243-3777
Practice Address - Fax:505-246-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0004X
NMPH000041083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155864OtherPK
NM46331018Medicaid