Provider Demographics
NPI:1558668350
Name:THE FORT HAMILTON HOSPITAL
Entity Type:Organization
Organization Name:THE FORT HAMILTON HOSPITAL
Other - Org Name:KHN PHARMACY - FORT HAMILTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:937-458-4932
Mailing Address - Street 1:4301 LYONS RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6446
Mailing Address - Country:US
Mailing Address - Phone:937-458-4934
Mailing Address - Fax:937-522-7198
Practice Address - Street 1:1010 CEREAL AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2784
Practice Address - Country:US
Practice Address - Phone:513-867-4496
Practice Address - Fax:513-867-4496
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE FORT HAMILTON HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-15
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OHPMY.022103050-033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3152412Medicaid
2128643OtherPK