Provider Demographics
NPI:1609940089
Name:DAYTON OSTEOPATHIC HOSPITAL
Entity Type:Organization
Organization Name:DAYTON OSTEOPATHIC HOSPITAL
Other - Org Name:HUBER HEALTH PRARMACY
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 1:8701 TROY PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1066
Practice Address - Country:US
Practice Address - Phone:937-585-3333
Practice Address - Fax:937-558-3331
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAYTON OSTEOPATHIC HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0213829503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2417316Medicaid