Provider Demographics
NPI:1811413529
Name:BESTCARE PHARMACY JAL LLC
Entity Type:Organization
Organization Name:BESTCARE PHARMACY JAL LLC
Other - Org Name:BESTCARE PHARMACY JAL LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANJITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLAPOTHU
Authorized Official - Suffix:
Authorized Official - Credentials:BE
Authorized Official - Phone:575-395-2103
Mailing Address - Street 1:PO BOX 8156
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87198-8156
Mailing Address - Country:US
Mailing Address - Phone:505-268-2030
Mailing Address - Fax:505-212-0888
Practice Address - Street 1:115 MAIN STREET
Practice Address - Street 2:
Practice Address - City:JAL
Practice Address - State:NM
Practice Address - Zip Code:88252
Practice Address - Country:US
Practice Address - Phone:575-395-2103
Practice Address - Fax:505-212-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH000044723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPH00004472OtherSTATE BOARD OF PHARMACY