1669016895 NPI number — TRINITY HEALTH PHARMACY SERVICES, LLC

Table of content: (NPI 1669016895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669016895 NPI number — TRINITY HEALTH PHARMACY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY HEALTH PHARMACY SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669016895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12279 BLUFFTON ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-343-7600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12279 BLUFFTON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-697-4277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2019

Additional Information

Authorized Official

Authorized Official Last Name:
REDDING
Authorized Official First Name:
DAMON
Authorized Official Middle Name:
Authorized Official Title or Position:
VP AND CHIEF PHARMACY OFFICER
Authorized Official Telephone Number:
734-343-7600

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0391994 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2521-43 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: PMP-1895 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: PO8489 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: PHAR1918 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 300033160 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: VS0172399 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 054.021498 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 12766690-1708 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: A9-0012676 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: IN2605 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: PHA-MOP-LIC-84404 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: RP-0003705 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 14929 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 266265 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: MO40003141 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: NR-51935 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: NR5450 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 008107334 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036.0134601 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com