Healthcare Provider Details

I. General information

NPI: 1669016895
Provider Name (Legal Business Name): TRINITY HEALTH PHARMACY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12279 BLUFFTON ROAD
FORT WAYNE IN
46809
US

IV. Provider business mailing address

12279 BLUFFTON ROAD
FORT WAYNE IN
46809
US

V. Phone/Fax

Practice location:
  • Phone: 407-697-4277
  • Fax:
Mailing address:
  • Phone: 734-343-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAMON REDDING
Title or Position: VP AND CHIEF PHARMACY OFFICER
Credential: PHARMD, MBA
Phone: 734-343-7600