Provider Demographics
NPI:1740663293
Name:ABQ BESTCARE PHARMACY -1 LLC
Entity type:Organization
Organization Name:ABQ BESTCARE PHARMACY -1 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PREM
Authorized Official - Middle Name:
Authorized Official - Last Name:KALIDINDI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:917-769-8014
Mailing Address - Street 1:10328 MARCHANT LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4505
Mailing Address - Country:US
Mailing Address - Phone:917-769-8014
Mailing Address - Fax:
Practice Address - Street 1:2929 COORS BLVD NW STE 110
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1272
Practice Address - Country:US
Practice Address - Phone:917-769-8014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH000040013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy