Provider Demographics
NPI:1316357379
Name:BANKS, EARNESTINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:EARNESTINE
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CHARRISE
Other - Middle Name:
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1901 S 25TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4711
Mailing Address - Country:US
Mailing Address - Phone:772-595-5150
Mailing Address - Fax:772-595-6560
Practice Address - Street 1:1901 S 25TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4711
Practice Address - Country:US
Practice Address - Phone:772-595-5150
Practice Address - Fax:772-595-6560
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 379411835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist