Healthcare Provider Details

I. General information

NPI: 1609620764
Provider Name (Legal Business Name): PHARMAPLUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 12/30/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9929 WEST SR 14
FORT WAYNE IN
46804-5769
US

IV. Provider business mailing address

1931 AZURITE PL
FORT WAYNE IN
46804-5265
US

V. Phone/Fax

Practice location:
  • Phone: 260-579-8854
  • Fax: 260-264-6747
Mailing address:
  • Phone: 260-579-8854
  • Fax: 260-264-6747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. SHERWIN O DAVIS
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 260-579-8854