Healthcare Provider Details

I. General information

NPI: 1306894787
Provider Name (Legal Business Name): BANDYS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 W WHITTAKER ST
SALEM IL
62881-2015
US

IV. Provider business mailing address

1413 W WHITTAKER ST P O BOX 546
SALEM IL
62881-2015
US

V. Phone/Fax

Practice location:
  • Phone: 618-548-4000
  • Fax: 618-548-3784
Mailing address:
  • Phone: 618-548-4000
  • Fax: 618-548-3784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number054008418
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIC SCOTT BANDY
Title or Position: OWNER RPH
Credential:
Phone: 618-548-4000