Provider Demographics
NPI:1306894787
Name:BANDYS PHARMACY INC
Entity type:Organization
Organization Name:BANDYS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER RPH
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-548-4000
Mailing Address - Street 1:1413 W WHITTAKER ST
Mailing Address - Street 2:P O BOX 546
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-2015
Mailing Address - Country:US
Mailing Address - Phone:618-548-4000
Mailing Address - Fax:618-548-3784
Practice Address - Street 1:1413 W WHITTAKER ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-2015
Practice Address - Country:US
Practice Address - Phone:618-548-4000
Practice Address - Fax:618-548-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054008418332B00000X
3336L0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL0155970001Medicare PIN
IL=========001Medicaid