Provider Demographics
NPI:1144355736
Name:BANDY DRUGS
Entity type:Organization
Organization Name:BANDY DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BANDY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-983-8272
Mailing Address - Street 1:905 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62951-1219
Mailing Address - Country:US
Mailing Address - Phone:618-983-8272
Mailing Address - Fax:618-983-7871
Practice Address - Street 1:905 GRAND AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON CITY
Practice Address - State:IL
Practice Address - Zip Code:62951-1219
Practice Address - Country:US
Practice Address - Phone:618-983-8272
Practice Address - Fax:618-983-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid