Provider Demographics
NPI:1134185838
Name:BANKS DRUG, INC.
Entity type:Organization
Organization Name:BANKS DRUG, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:803-685-5326
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:RIDGE SPRING
Mailing Address - State:SC
Mailing Address - Zip Code:29129-0308
Mailing Address - Country:US
Mailing Address - Phone:803-685-5326
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-22
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500024863336C0003X, 3336C0003X, 3336C0003X
SC24863104A0630X, 3104A0625X, 311Z00000X, 311ZA0620X, 313M00000X, 310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDME069Medicaid
SC724864Medicaid
NC7703587Medicaid
SCDME069Medicaid