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Organization
KETTERING MEDICAL CENTER
Active
Organization
KETTERING MEDICAL CENTER
Active
Parent organization
KETTERING MEDICAL CENTER
Other names
Kettering Health Pharmacy Miamisburg
Organization subpart
Yes
Provider details
NPI number
Legal business name
KETTERING MEDICAL CENTER
Authorized official
MR. KEVIN BLACKBURN RPH (DIRECTOR OF PHARMACY)
(937) 458-4932
Entity
Organization
Contact information
Practice address
4000 MIAMISBURG-CENTERVILLE RD, MIAMISBURG, OH 45342
(937) 384-3868
(937) 384-3868
Mailing address
4301 LYONS RD., MIAMISBURG, OH 45342
(937) 458-4934
(937) 522-7198
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
021076650
OH
3336C0003X
Community/Retail Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2085818
—
OH
05
—
2805818
—
OH
01
—
3666039
OTHER ID NUMBER
—
Enumeration date
11/20/2006
Last updated
01/22/2025
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