Provider Demographics
NPI:1821122987
Name:BANDY, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BANDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 COPPER OAKS PL
Mailing Address - Street 2:
Mailing Address - City:WOODSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21798-8346
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 E FREDERICK ST
Practice Address - Street 2:
Practice Address - City:WALKERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21793-8234
Practice Address - Country:US
Practice Address - Phone:301-845-4401
Practice Address - Fax:301-845-1114
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist