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General NPI Number Information
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NPI Number | 1174083190
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Entity Type | Organization
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Legal Business Name | MARY IMOGENE BASSETT HOSPITAL
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 1 FOXCARE DR STE 215
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City | ONEONTA
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State | NY
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Zip | 13820-2154
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Country | US
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Telephone | 607-431-5284
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FOXCARE DR STE 215
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City | ONEONTA
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State | NY
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Zip | 13820-2154
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Country | US
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Telephone | 607-431-5284
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Fax |
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Authorized Official
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Title or Position | NETWORK PHARMACY DIRECTOR
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Name | DR. KELLY RUDD
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Credential | PHARMD
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Telephone | 607-547-3637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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