# IRA DAVENPORT MEMORIAL HOSPITAL INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** IRA DAVENPORT MEMORIAL HOSPITAL PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659312080
- **Authorized official:** MR. JONATHAN I. LAWRENCE (PRESIDENT & CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (607) 776-8500

## Contact information

- **Practice address:** 7571 STATE ROUTE 54, BATH, NY 14810-9504
- **Practice address phone:** (607) 776-8500
- **Practice address fax:** (607) 776-8817
- **Mailing address:** 7571 STATE ROUTE 54, BATH, NY 14810-9504
- **Mailing address phone:** (607) 776-8500
- **Mailing address fax:** (607) 776-8817

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0002X | Clinic Pharmacy | — | NULL | — |
| 3336I0012X | Institutional Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 014851 | NY | Yes |

## Other

- **Enumeration date:** 06/09/2006
- **Last updated:** 03/04/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00332816 | — | NY |
| 05 | — | 01151844 | — | NY |
| 01 | — | 2067348 | PK | — |