Provider Demographics
NPI:1265980361
Name:BANDY, KASONDRA (PHARMD)
Entity type:Individual
Prefix:
First Name:KASONDRA
Middle Name:
Last Name:BANDY
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:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:PINCH
Mailing Address - State:WV
Mailing Address - Zip Code:25156-0701
Mailing Address - Country:US
Mailing Address - Phone:304-382-7612
Mailing Address - Fax:
Practice Address - Street 1:218 MARKET ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-1316
Practice Address - Country:US
Practice Address - Phone:304-927-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-17
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0009831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist