Healthcare Provider Details

I. General information

NPI: 1639475890
Provider Name (Legal Business Name): SHERWIN O DAVIS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10170 ILLINOIS RD
FORT WAYNE IN
46804-5774
US

IV. Provider business mailing address

2400 E CENTER ST
WARSAW IN
46580-3817
US

V. Phone/Fax

Practice location:
  • Phone: 260-436-6021
  • Fax:
Mailing address:
  • Phone: 260-579-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26023453A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26023453A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: