Organization · Type 2 NPI

Kettering Medical Center

Long Term Care Pharmacy · Miamisburg, OH

NPI number 1205005063 Active

Practice location

4301 Lyons Rd
Miamisburg, OH 45342

Fax (937) 458-4942

Specialties and licenses

Taxonomy	Code	License
Pharmacy	333600000X	None listed
Long Term Care Pharmacy Primary	3336L0003X	None listed

Long Term Care Pharmacy: A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

6 other providers at this address

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NPI record

NPI: 1205005063
Entity type: Organization (Type 2)
Issued: Feb 26, 2008
Last updated: Apr 8, 2021
Status: Active
Subpart: Yes of Kettering Medical Center

Other names

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Collaborative Pharmacy Services · doing business as

Authorized official

Mr. James Kevin Blackburn, RPH
Director of Pharmacy
(937) 458-4932

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1205005063

Kettering Medical Center's National Provider Identifier is 1205005063, issued on Feb 26, 2008. The primary taxonomy on file is Long Term Care Pharmacy (3336L0003X), and the practice location is in Miamisburg, OH. The record was last updated on Apr 8, 2021.