Organization
OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.
Active
Other names
Lourdes Retail Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SHAYNE WILCOX (SUPERVISING PHARMACIST)
(607) 798-5944
Entity
Organization
Contact information
Practice address
169 RIVERSIDE DR, BINGHAMTON, NY 13905-4246
(607) 798-5944
(607) 798-5972
Mailing address
169 RIVERSIDE DR, BINGHAMTON, NY 13905-4246
(607) 798-5944
(607) 798-5972
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
023594
NY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01909851
—
NY
01
—
2063510
PK
—
Enumeration date
06/12/2006
Last updated
10/16/2019
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