Healthcare Provider Details

I. General information

NPI: 1942242243
Provider Name (Legal Business Name): OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 RIVERSIDE DR
BINGHAMTON NY
13905-4246
US

IV. Provider business mailing address

169 RIVERSIDE DR RETAIL PHARMACY
BINGHAMTON NY
13905-4246
US

V. Phone/Fax

Practice location:
  • Phone: 607-798-5944
  • Fax: 607-798-5972
Mailing address:
  • Phone: 607-798-5944
  • Fax: 607-798-5972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number023594
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

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