Beavercreek Medical Center

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

022185500 Issued in OH

Legal business name

BEAVERCREEK MEDICAL CENTER

Doing business as

Kettering Health Pharmacy Soin

Practice address

3535 Pentagon Blvd
Beavercreek, OH 45431

Phone

(937) 458-4934

Fax

(937) 702-4909

NPI assigned

Mar 2, 2012

Last updated

Jan 27, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

BEAVERCREEK MEDICAL CENTERAs reported in NPPES

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

Authorized official

Name

Mr. Kevin Blackburn, RPH

Title

Director of Pharmacy

Phone

(937) 458-4932

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Kettering Health Pharmacy Soin Doing business as

Tax ID family

Beavercreek Medical Center4 organizations share this tax ID, including this one

Part of

Beavercreek Medical Center

Other organizations with this tax ID 3

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

• Beavercreek Medical Center

  dba Kettering Health Primary Care, A Service of Soin Medical Center

  • Rural Health Clinic/Center
  • Wilmington, OH
  • NPI 1558093286
  NPD tax ID
• Beavercreek Medical Center

  dba Soin Medical Center

  • General Acute Care Hospital
  • Beavercreek, OH
  • NPI 1760764849
  NPD tax ID
• Beavercreek Medical Center

  dba Kettering Health Primary Care, A Service of Soin Medical Center

  • Rural Health Clinic/Center
  • Cedarville, OH
  • NPI 1821959560
  NPD tax ID

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

{
    "created_epoch": "1330646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1497029854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 LYONS RD",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453426446",
            "telephone_number": "937-458-4934",
            "fax_number": "937-522-7198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 PENTAGON BLVD",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "45431",
            "telephone_number": "937-458-4934",
            "fax_number": "937-702-4909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVERCREEK MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEAVERCREEK MEDICAL CENTER",
        "enumeration_date": "2012-03-02",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "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_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "022185500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3680318",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0065361",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kettering Health Pharmacy Soin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Beavercreek Township (Beavercreek Township Fire Department)
• Nicholas Beecroft
• Brocton Begley

• Community/Retail Pharmacy in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Community/Retail Pharmacy in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; 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.