Provider Demographics
NPI:1114108735
Name:BANKS PHARMACY
Entity Type:Organization
Organization Name:BANKS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-869-9799
Mailing Address - Street 1:100 RIDGE MEDICAL PLAZA
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29824
Mailing Address - Country:US
Mailing Address - Phone:803-637-5757
Mailing Address - Fax:803-637-9996
Practice Address - Street 1:100 RIDGE MEDICAL PLAZA
Practice Address - Street 2:SUITE 101
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824
Practice Address - Country:US
Practice Address - Phone:803-637-5757
Practice Address - Fax:803-637-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC797882Medicaid
6042730001Medicare NSC