Provider Demographics
NPI:1639507502
Name:BANES, BRENDON (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:
Last Name:BANES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 STONEWALL CT
Mailing Address - Street 2:APT. # 2306
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7983
Mailing Address - Country:US
Mailing Address - Phone:678-333-6208
Mailing Address - Fax:
Practice Address - Street 1:5215 ASHLEY PHOSPHATE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-2823
Practice Address - Country:US
Practice Address - Phone:843-767-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPH-14362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist