James Kevin Blackburn, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

03120530 Issued in OH

Practice address

3700 Southern Blvd
Kettering, OH 45429-1265

Phone

(937) 458-4932

Fax

(937) 522-7394

NPI assigned

Apr 7, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666828800000",
    "number": "1033748413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3104 SETON HILL DR",
            "city": "BELLBROOK",
            "state": "OH",
            "postal_code": "453058767",
            "telephone_number": "937-344-7019",
            "fax_number": "937-522-7394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 SOUTHERN BLVD",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291265",
            "telephone_number": "937-458-4932",
            "fax_number": "937-522-7394"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4301 Lyons Rd",
            "address_purpose": "LOCATION",
            "city": "Miamisburg",
            "state": "OH",
            "postal_code": "453426446",
            "country_code": "US",
            "telephone_number": "937-458-4932",
            "fax_number": "937-522-7394",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "JAMES",
        "middle_name": "KEVIN",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-07",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OH",
            "license": "03120530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST",
            "identifier": "03120530",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ruchi Bisen, MD
• Brian LM Bishop
• Laurel Marie Bishop, RN
• Cassandra Leigh Black, CRNA
• Lindsay Black
• Blanche E Pearson
• Ellen Mae Blanco
• Renee Blankenship
• Wanda Irene Blatter, APRN
• Jamie Bleyer, M.D.

• Pharmacist in Kettering, OH
• Providers in Kettering, OH by specialty
• Pharmacist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.