Healthcare Provider Details

I. General information

NPI: 1629511688
Provider Name (Legal Business Name): DAYTON OSTEOPATHIC HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SOUTHERN BLVD STE 105
KETTERING OH
45429-1226
US

IV. Provider business mailing address

4301 LYONS RD
MIAMISBURG OH
45342-6446
US

V. Phone/Fax

Practice location:
  • Phone: 937-281-3883
  • Fax: 937-281-3879
Mailing address:
  • Phone: 937-458-4934
  • Fax: 937-291-3879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPMY022662150-03
License Number StateOH

VIII. Authorized Official

Name: MRS. LYNDA PATTERSON
Title or Position: ADMIN. ASST. CREDENTIALING
Credential: CPHT
Phone: 937-458-4934