Healthcare Provider Details

I. General information

NPI: 1033641121
Provider Name (Legal Business Name): BANKS DRUG LTC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 E MAIN ST
RIDGE SPRING SC
29129-9139
US

IV. Provider business mailing address

PO BOX 308
RIDGE SPRING SC
29129-0308
US

V. Phone/Fax

Practice location:
  • Phone: 803-233-3557
  • Fax: 803-250-2623
Mailing address:
  • Phone: 803-233-3557
  • Fax: 803-250-2623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number17163
License Number StateSC

VIII. Authorized Official

Name: LEE BANKS
Title or Position: PRESIDENT
Credential:
Phone: 803-685-5326