NPIMap

Organization Active NPI

Our Lady of Lourdes Memorial Hospital, Inc.

Doing business as Lourdes Pharmacy

  • Community/Retail Pharmacy
  • Vestal, NY
National Provider Identifier
1063824852
Registry record updated Jun 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
032604 Issued in NY
Legal business name
OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.
Doing business as
Lourdes Pharmacy
Practice address
3101 Shippers Rd Ste 104
Vestal, NY 13850-2003
Phone
(607) 251-2151
Fax
(607) 251-2194
NPI assigned
May 28, 2014
Last updated
Jun 18, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
OUR LADY OF LOURDES MEMORIAL HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shayne Wilcox
Title
Director, Community Pharmacy
Phone
(607) 798-5911

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 032604 NY Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

3101 Shippers Rd Ste 104
Vestal, NY 13850-2003

Mailing address

3101 Shippers Rd
Suite 104
Vestal, NY 13850-2003
Phone (607) 251-2151

Other identifiers 1

IdentifierTypeStateIssuer
2145824OtherPK

Other names 1

  • Lourdes Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170607002486 NY DME Supplier - Pharmacy 1254237779 Practice locations: Vestal, NY
O20220713001636 NY Part B Supplier - Pharmacy 1254237779 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Binghamton, NY; Johnson City, NY; Vestal, NY

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Our Lady of Lourdes Memorial Hospi3101 Shippers Rd, Vestal, NY 13850(607) 251-2191 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Oct 1, 1984

National Provider Directory

National Provider Directory
Tax ID family
Ashokkumar Shah12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3101 Shippers Rd
Ste 104
Vestal, NY 13850
Phone (607) 251-2151

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781740800000",
    "number": "1063824852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 SHIPPERS RD",
            "address_2": "SUITE 104",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138502003",
            "telephone_number": "607-251-2151",
            "fax_number": "607-251-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 SHIPPERS RD STE 104",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138502003",
            "telephone_number": "607-251-2151",
            "fax_number": "607-251-2194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OUR LADY OF LOURDES MEMORIAL HOSPITAL INC",
        "enumeration_date": "2014-05-28",
        "last_updated": "2026-06-18",
        "certification_date": "2026-06-18",
        "status": "A",
        "authorized_official_last_name": "WILCOX",
        "authorized_official_first_name": "SHAYNE",
        "authorized_official_title_or_position": "DIRECTOR, COMMUNITY PHARMACY",
        "authorized_official_telephone_number": "607-798-5911"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "032604",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2145824",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lourdes Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vestal, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.