Provider Demographics
NPI:1912425109
Name:BESTCARE PHARMACY DEMING
Entity type:Organization
Organization Name:BESTCARE PHARMACY DEMING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:POTHULA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:505-268-2030
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 1:812 E FLORIDA ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-5312
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:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH000045103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPH00004510OtherSTATE BOARD OF PHARMACY