Provider Demographics
NPI:1649300625
Name:BANDYS PRESCRIPTIONS, INC
Entity type:Organization
Organization Name:BANDYS PRESCRIPTIONS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BANDY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-283-0054
Mailing Address - Street 1:2720 NORTH CENTER
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062
Mailing Address - Country:US
Mailing Address - Phone:618-292-0269
Mailing Address - Fax:
Practice Address - Street 1:2720 NORTH CENTER
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062
Practice Address - Country:US
Practice Address - Phone:618-292-0269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies