Healthcare Provider Details

I. General information

NPI: 1710332002
Provider Name (Legal Business Name): OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 STATE ST
BINGHAMTON NY
13901-2378
US

IV. Provider business mailing address

477 STATE ST
BINGHAMTON NY
13901-2378
US

V. Phone/Fax

Practice location:
  • Phone: 607-584-9376
  • Fax: 607-584-9380
Mailing address:
  • Phone: 607-584-9376
  • Fax: 607-584-9380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number029413
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHAYNE WILCOX
Title or Position: DIRECTOR, COMMUNITY PHARMACY
Credential:
Phone: 607-798-5911