# KETTERING MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KETTERING MEDICAL CENTER
- **Other names:** COLLABORATIVE PHARMACY SERVICES
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1205005063
- **Legal business name:** KETTERING MEDICAL CENTER
- **Authorized official:** MR. JAMES KEVIN BLACKBURN RPH (DIRECTOR OF PHARMACY)
- **Authorized official phone:** (937) 458-4932

## Contact information

- **Practice address:** 4301 LYONS RD, MIAMISBURG, OH 45342
- **Practice address phone:** (937) 458-4949
- **Practice address fax:** (937) 458-4942
- **Mailing address:** 4301 LYONS RD, MIAMISBURG, OH 45342
- **Mailing address phone:** (937) 458-4949
- **Mailing address fax:** (937) 458-4942

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 02/26/2008
- **Last updated:** 04/08/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0232000177 | OH BOARD OF PHARMACY LIC. | OH |
| 05 | — | 0408149 | — | OH |
| 01 | — | 2081107 | PK | — |