Organization
OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.
Active
Other names
Lourdes Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GREGG HAYTON (CFO)
(607) 798-5285
Entity
Organization
Contact information
Practice address
3101 SHIPPERS RD STE 104, VESTAL, NY 13850-2003
(607) 251-2151
(607) 251-2194
Mailing address
3101 SHIPPERS RD, SUITE 104, VESTAL, NY 13850-2003
(607) 251-2151
(607) 251-2194
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
032604
NY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2145824
PK
—
Enumeration date
05/28/2014
Last updated
05/28/2014
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