Provider Demographics
NPI:1245741347
Name:BANDY'S LTC LLC
Entity Type:Organization
Organization Name:BANDY'S LTC LLC
Other - Org Name:BANDY'S LONG TERM CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-548-4000
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-0546
Mailing Address - Country:US
Mailing Address - Phone:618-548-4000
Mailing Address - Fax:618-548-4059
Practice Address - Street 1:1415 W WHITTAKER ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-2015
Practice Address - Country:US
Practice Address - Phone:618-548-4000
Practice Address - Fax:618-548-4059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371163531001Medicaid