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General NPI Number Information
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NPI Number | 1912370941
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Entity Type | Individual
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Provider Name | OTIS BANDY JR.
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Gender | Male
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Dates
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Enumeration Date | 11/13/2015
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Last Update Date | 11/13/2015
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Provider Practice Location Address
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Address Line | 317 SOUTH MAIN STREET
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City | WEATHERFORD
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State | TX
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Zip | 76086
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Country | US
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Telephone | 817-594-5771
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Fax |
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Provider Business Mailing Address
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Address Line | 300 NORTH HIGHWAY 171
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City | GODLEY
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State | TX
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Zip | 76044-0095
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 22108
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License Number State | TX
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