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Organization
KETTERING MEDICAL CENTER
Active
Organization
KETTERING MEDICAL CENTER
Active
Parent organization
KETTERING MEDICAL CENTER
Other names
COLLABORATIVE PHARMACY SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
KETTERING MEDICAL CENTER
Authorized official
MR. JAMES KEVIN BLACKBURN RPH (DIRECTOR OF PHARMACY)
(937) 458-4932
Entity
Organization
Contact information
Practice address
4301 LYONS RD, MIAMISBURG, OH 45342
(937) 458-4949
(937) 458-4942
Mailing address
4301 LYONS RD, MIAMISBURG, OH 45342
(937) 458-4949
(937) 458-4942
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0232000177
OH BOARD OF PHARMACY LIC.
OH
05
—
0408149
—
OH
01
—
2081107
PK
—
Enumeration date
02/26/2008
Last updated
04/08/2021
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