Basic Information
| Provider Information | |||||||||
| NPI: | 1386879658 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEST PHARMACY GROUP INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MIRAGE MEDICAL CENTER PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 AMIGOS DR STE A | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923736283 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 35400 BOB HOPE DR | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | RANCHO MIRAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922701772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603282115 | ||||||||
| FaxNumber: | 7602021333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2009 | ||||||||
| LastUpdateDate: | 12/20/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | REDDY | ||||||||
| AuthorizedOfficialFirstName: | PRASAD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9097938205 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336L0003X | N | Suppliers | Pharmacy | Long Term Care Pharmacy | 333600000X | N | Suppliers | Pharmacy | 3336C0003X | 49961 | CA | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 5634527 | 01 | NCPDP PROVIDER IDENTIFICATION NUMBER | OTHER |