Provider Demographics
NPI:1033748413
Name:BLACKBURN, JAMES KEVIN (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KEVIN
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 SETON HILL DR
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-8767
Mailing Address - Country:US
Mailing Address - Phone:937-344-7019
Mailing Address - Fax:937-522-7394
Practice Address - Street 1:3700 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1265
Practice Address - Country:US
Practice Address - Phone:937-458-4932
Practice Address - Fax:937-522-7394
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03120530OtherPHARMACIST