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Organization
KETTERING MEDICAL CENTER
Active
Organization
KETTERING MEDICAL CENTER
Active
Other names
KHN Pharmacy Springboro
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BLACKBURN RPH (DIRECTOR OF PHARMACY)
(937) 458-4932
Entity
Organization
Contact information
Practice address
825 N MAIN ST, SPRINGBORO, OH 45066-2100
(937) 762-5090
(937) 762-5091
Mailing address
825 N MAIN ST, SPRINGBORO, OH 45066-2100
(937) 762-5090
(937) 522-7198
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0002X
Clinic Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PMY.022604450-03
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0171911
—
OH
01
—
2158450
PK
—
Enumeration date
03/25/2016
Last updated
02/28/2017
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