Provider Demographics
NPI:1104956622
Name:BANDYS PRESCRIPTION, INC
Entity type:Organization
Organization Name:BANDYS PRESCRIPTION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BANDY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-662-4016
Mailing Address - Street 1:100 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:IL
Mailing Address - Zip Code:62839-1612
Mailing Address - Country:US
Mailing Address - Phone:618-662-4016
Mailing Address - Fax:
Practice Address - Street 1:100 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IL
Practice Address - Zip Code:62839-1612
Practice Address - Country:US
Practice Address - Phone:618-662-4016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies