NPIMap

Organization Active NPI

Kettering Medical Center

Doing business as Kettering Health Pharmacy Main Campus

  • Community/Retail Pharmacy
  • Kettering, OH
National Provider Identifier
1871667253
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
02051850 Issued in OH
Legal business name
KETTERING MEDICAL CENTER
Doing business as
Kettering Health Pharmacy Main Campus
Practice address
3535 Southern Blvd
Kettering, OH 45429-1221
Phone
(937) 395-8171
Fax
(937) 395-8382
NPI assigned
Nov 20, 2006
Last updated
Jan 22, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
KETTERING MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 02051850 OH Primary

Addresses

Primary practice location

3535 Southern Blvd
Kettering, OH 45429-1221

Mailing address

4301 Lyons Rd
Miamisburg, OH 45342-6446
Phone (937) 458-4932

Other identifiers 1

IdentifierTypeStateIssuer
0678995MedicaidOH

Other names 1

  • Kettering Health Pharmacy Main Campus Doing business as

National Provider Directory

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

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": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1871667253",
    "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": "937-458-4932",
            "fax_number": "937-522-7198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 SOUTHERN BLVD",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291221",
            "telephone_number": "937-395-8171",
            "fax_number": "937-395-8382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETTERING MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KETTERING MEDICAL CENTER",
        "enumeration_date": "2006-11-20",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "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": "02051850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0678995",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kettering Health Pharmacy Main Campus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kettering, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.