# KETTERING MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KETTERING MEDICAL CENTER
- **Other names:** Kettering Health Pharmacy Main Campus
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1871667253
- **Legal business name:** KETTERING MEDICAL CENTER
- **Authorized official:** MR. KEVIN BLACKBURN RPH (DIRECTOR OF PHARMACY)
- **Authorized official phone:** (937) 458-4932

## Contact information

- **Practice address:** 3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
- **Practice address phone:** (937) 395-8171
- **Practice address fax:** (937) 395-8382
- **Mailing address:** 4301 LYONS RD, MIAMISBURG, OH 45342-6446
- **Mailing address phone:** (937) 458-4932
- **Mailing address fax:** (937) 522-7198

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 02051850 | OH | Yes |

## Other

- **Enumeration date:** 11/20/2006
- **Last updated:** 01/22/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0678995 | — | OH |