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General NPI Number Information
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NPI Number | 1508576612
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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 | 11/29/2022
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 501 REYNOLDS RD
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City | JOHNSON CITY
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State | NY
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Zip | 13790-1311
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Country | US
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Telephone | 607-798-5533
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Fax | 607-798-5534
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Provider Business Mailing Address
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Address Line | 501 REYNOLDS RD
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City | JOHNSON CITY
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State | NY
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Zip | 13790-1311
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Country | US
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Telephone | 607-798-5533
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Fax | 607-798-5534
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Authorized Official
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Title or Position | OUTPATIENT PHARMACY MANAGER
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Name | SHAYNE WILCOX
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Credential | PHARM D
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Telephone | 607-798-5911
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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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