Provider Demographics
NPI:1760852271
Name:ABQ BESTCARE PHARMACY 2 LLC
Entity Type:Organization
Organization Name:ABQ BESTCARE PHARMACY 2 LLC
Other - Org Name:ABQ BESTCARE PHARMACY 2 LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RANJITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLAPOTHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-675-2012
Mailing Address - Street 1:5400 GIBSON BLVD SE
Mailing Address - Street 2:(GIBSON MEDICAL CENTER PHARMACY)
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4729
Mailing Address - Country:US
Mailing Address - Phone:505-268-2030
Mailing Address - Fax:505-268-2022
Practice Address - Street 1:5400 GIBSON BLVD SE
Practice Address - Street 2:(GIBSON MEDICAL CENTER PHARMACY)
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-4729
Practice Address - Country:US
Practice Address - Phone:505-268-2030
Practice Address - Fax:505-268-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
NMPH000040533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154324OtherPK
NM74501852Medicaid