Provider Demographics
NPI:1437164076
Name:BANE DRUGS INC
Entity Type:Organization
Organization Name:BANE DRUGS INC
Other - Org Name:BANE DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-833-1922
Mailing Address - Street 1:360 W MONTICELLO ST
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-3206
Mailing Address - Country:US
Mailing Address - Phone:601-833-1922
Mailing Address - Fax:601-833-0245
Practice Address - Street 1:360 W MONTICELLO ST
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-3206
Practice Address - Country:US
Practice Address - Phone:601-833-1922
Practice Address - Fax:601-833-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS004020113336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1243876Medicaid
MS0030198Medicaid
2050625OtherPK