Provider Demographics
NPI:1790210839
Name:MUKTA LLC
Entity Type:Organization
Organization Name:MUKTA LLC
Other - Org Name:BESTRX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-210-1811
Mailing Address - Street 1:400 ABBY CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6429
Mailing Address - Country:US
Mailing Address - Phone:864-991-7972
Mailing Address - Fax:864-210-1810
Practice Address - Street 1:1103 N MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:FOUNTAIN INN
Practice Address - State:SC
Practice Address - Zip Code:29644-1336
Practice Address - Country:US
Practice Address - Phone:864-210-1811
Practice Address - Fax:864-210-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC172003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC717200Medicaid