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General NPI Number Information
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NPI Number | 1063824852
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Entity Type | Organization
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Legal Business Name | OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 3101 SHIPPERS RD STE 104
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City | VESTAL
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State | NY
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Zip | 13850-2003
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Country | US
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Telephone | 607-251-2151
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Fax | 607-251-2194
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Provider Business Mailing Address
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Address Line | 3101 SHIPPERS RD SUITE 104
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City | VESTAL
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State | NY
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Zip | 13850-2003
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Country | US
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Telephone | 607-251-2151
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Fax | 607-251-2194
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Authorized Official
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Title or Position | CFO
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Name | GREGG HAYTON
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Credential |
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Telephone | 607-798-5285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 032604
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License Number State | NY
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