Healthcare Provider Details

I. General information

NPI: 1144355736
Provider Name (Legal Business Name): BANDY DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 GRAND AVE
JOHNSTON CITY IL
62951-1219
US

IV. Provider business mailing address

905 GRAND AVE
JOHNSTON CITY IL
62951-1219
US

V. Phone/Fax

Practice location:
  • Phone: 618-983-8272
  • Fax: 618-983-7871
Mailing address:
  • Phone: 618-983-8272
  • Fax: 618-983-7871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. GARY JOSEPH BANDY
Title or Position: OWNER
Credential: RPH
Phone: 618-983-8272