NPIMap

Organization Active NPI

Kettering Medical Center

Doing business as KHN Pharmacy Springboro

  • Community/Retail Pharmacy
  • Springboro, OH
National Provider Identifier
1487016796
Registry record updated Feb 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PMY.022604450-03 Issued in OH
Legal business name
KETTERING MEDICAL CENTER
Doing business as
KHN Pharmacy Springboro
Practice address
825 N Main St
Springboro, OH 45066-2100
Phone
(937) 762-5090
Fax
(937) 762-5091
NPI assigned
Mar 25, 2016
Last updated
Feb 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2017

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

Authorized official

Name
Kevin Blackburn, RPH
Title
Director of Pharmacy
Phone
(937) 458-4932

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Clinic Pharmacy 3336C0002X NU
Community/Retail Pharmacy 3336C0003X PMY.022604450-03 OH Primary

Addresses

Primary practice location

825 N Main St
Springboro, OH 45066-2100

Mailing address

825 N Main St
Springboro, OH 45066-2100
Phone (937) 762-5090

Other identifiers 2

IdentifierTypeStateIssuer
0171911MedicaidOH
2158450OtherPK

Other names 1

  • KHN Pharmacy Springboro Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kettering Memorial Hosp12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1458864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488240000000",
    "number": "1487016796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 N MAIN ST",
            "city": "SPRINGBORO",
            "state": "OH",
            "postal_code": "450662100",
            "telephone_number": "937-762-5090",
            "fax_number": "937-522-7198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 N MAIN ST",
            "city": "SPRINGBORO",
            "state": "OH",
            "postal_code": "450662100",
            "telephone_number": "937-762-5090",
            "fax_number": "937-762-5091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETTERING MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-25",
        "last_updated": "2017-02-28",
        "status": "A",
        "authorized_official_last_name": "BLACKBURN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "937-458-4932",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "PMY.022604450-03",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0171911",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2158450",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KHN Pharmacy Springboro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springboro, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; 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.