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General NPI Number Information
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NPI Number | 1033748413
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Entity Type | Individual
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Provider Name | JAMES KEVIN BLACKBURN RPH
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Gender | Male
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Dates
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Enumeration Date | 04/07/2020
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 3700 SOUTHERN BLVD
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City | KETTERING
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State | OH
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Zip | 45429-1265
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Country | US
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Telephone | 937-458-4932
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Fax | 937-522-7394
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Provider Business Mailing Address
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Address Line | 3104 SETON HILL DR
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City | BELLBROOK
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State | OH
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Zip | 45305-8767
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Country | US
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Telephone | 937-344-7019
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Fax | 937-522-7394
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03120530
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License Number State | OH
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