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
—
—
3336C0002X
Clinic Pharmacy
—
—
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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