# KETTERING MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** KHN Pharmacy Springboro
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487016796
- **Authorized official:** KEVIN BLACKBURN RPH (DIRECTOR OF PHARMACY)
- **Authorized official phone:** (937) 458-4932

## Contact information

- **Practice address:** 825 N MAIN ST, SPRINGBORO, OH 45066-2100
- **Practice address phone:** (937) 762-5090
- **Practice address fax:** (937) 762-5091
- **Mailing address:** 825 N MAIN ST, SPRINGBORO, OH 45066-2100
- **Mailing address phone:** (937) 762-5090
- **Mailing address fax:** (937) 522-7198

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0002X | Clinic Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PMY.022604450-03 | OH | Yes |

## Other

- **Enumeration date:** 03/25/2016
- **Last updated:** 02/28/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0171911 | — | OH |
| 01 | — | 2158450 | PK | — |