Organization
IRA DAVENPORT MEMORIAL HOSPITAL INC
Active
Other names
IRA DAVENPORT MEMORIAL HOSPITAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN I. LAWRENCE (PRESIDENT & CHIEF EXECUTIVE OFFICER)
(607) 776-8500
Entity
Organization
Contact information
Practice address
7571 STATE ROUTE 54, BATH, NY 14810-9504
(607) 776-8500
(607) 776-8817
Mailing address
7571 STATE ROUTE 54, BATH, NY 14810-9504
(607) 776-8500
(607) 776-8817
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336I0012X
Institutional Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
014851
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00332816
—
NY
05
—
01151844
—
NY
01
—
2067348
PK
—
Enumeration date
06/09/2006
Last updated
03/04/2019
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