Provider Demographics
NPI:1942711346
Name:BANKS, LEE CARTER (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:CARTER
Last Name:BANKS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:LEE
Other - Middle Name:CARTER
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:P O BOX 308
Mailing Address - Street 2:
Mailing Address - City:RIDGE SPRING
Mailing Address - State:SC
Mailing Address - Zip Code:29129
Mailing Address - Country:US
Mailing Address - Phone:706-799-5442
Mailing Address - Fax:803-685-5442
Practice Address - Street 1:630 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGE SPRING
Practice Address - State:SC
Practice Address - Zip Code:29129-9139
Practice Address - Country:US
Practice Address - Phone:803-685-5326
Practice Address - Fax:803-685-5442
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist