Provider Demographics
NPI:1033641121
Name:BANKS DRUG LTC LLC
Entity Type:Organization
Organization Name:BANKS DRUG LTC LLC
Other - Org Name:BANKS DRUG LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-685-5326
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:RIDGE SPRING
Mailing Address - State:SC
Mailing Address - Zip Code:29129-0308
Mailing Address - Country:US
Mailing Address - Phone:803-233-3557
Mailing Address - Fax:803-250-2623
Practice Address - Street 1:632 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGE SPRING
Practice Address - State:SC
Practice Address - Zip Code:29129-9139
Practice Address - Country:US
Practice Address - Phone:803-233-3557
Practice Address - Fax:803-250-2623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC171633336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168452OtherPK