Provider Demographics
NPI:1659095628
Name:BANDA, AUBREE MICHELLE JUSTUS (PHARMD)
Entity Type:Individual
Prefix:
First Name:AUBREE
Middle Name:MICHELLE JUSTUS
Last Name:BANDA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:SC
Mailing Address - Zip Code:29831-2631
Mailing Address - Country:US
Mailing Address - Phone:803-341-1411
Mailing Address - Fax:
Practice Address - Street 1:235 ROBERT C DANIEL JR PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-0800
Practice Address - Country:US
Practice Address - Phone:706-733-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43536183500000X
GARPH033741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist