MEDICARE: MARK BANDY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11724	MD

General Provider Information

NPI Number	:	1821122987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK BANDY

Provider Business Mailing Address
First Line	:	406 COPPER OAKS PL
Second Line	:
City	:	WOODSBORO
State	:	MD
Zip	:	21798-8346
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 E FREDERICK ST
Second Line	:
City	:	WALKERSVILLE
State	:	MD
Zip	:	21793-8234
Country	:	US
Telephone Number	:	301-845-4401
Fax Number	:	301-845-1114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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