Provider Demographics
NPI:1063876183
Name:ABQ BESTCARE PHARMACY 3 LLC
Entity type:Organization
Organization Name:ABQ BESTCARE PHARMACY 3 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANJITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLAPOTHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-769-8014
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:505-268-2030
Practice Address - Street 1:2901 TRANSPORT ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4382
Practice Address - Country:US
Practice Address - Phone:505-268-2030
Practice Address - Fax:505-268-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NMPH000041863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158122OtherPK