Provider Demographics
NPI:1457880114
Name:BESTCARE PHARMACY-MORA, LLC
Entity Type:Organization
Organization Name:BESTCARE PHARMACY-MORA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALIDINDI
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:575-387-5703
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:575-387-5703
Mailing Address - Fax:505-212-0888
Practice Address - Street 1:#3 A033 BESTCARE PHARMACY-MORA LLC
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:NM
Practice Address - Zip Code:87732
Practice Address - Country:US
Practice Address - Phone:575-387-5703
Practice Address - Fax:505-212-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH000044223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy