Provider Demographics
NPI:1669542189
Name:BESTCARE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:BESTCARE HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOJITRA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:909-498-1801
Mailing Address - Street 1:570 S MOUNT VERNON AVE STE F2
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-2760
Mailing Address - Country:US
Mailing Address - Phone:909-498-1801
Mailing Address - Fax:909-498-1805
Practice Address - Street 1:570 S MOUNT VERNON AVE STE F2
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-2760
Practice Address - Country:US
Practice Address - Phone:909-498-1801
Practice Address - Fax:909-498-1805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
CAPHY53698333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669542189Medicaid
CAPHY59135OtherBOP
CA0545066OtherNABP NUMBER
CAPHY53698OtherPHARMACY STATE LICENSE
FH2005533OtherDEA REGISTRATION