Provider Demographics
NPI:1669016895
Name:TRINITY HEALTH PHARMACY SERVICES, LLC
Entity type:Organization
Organization Name:TRINITY HEALTH PHARMACY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AND CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:734-343-7600
Mailing Address - Street 1:12279 BLUFFTON ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46809
Mailing Address - Country:US
Mailing Address - Phone:734-343-7600
Mailing Address - Fax:
Practice Address - Street 1:12279 BLUFFTON ROAD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46809
Practice Address - Country:US
Practice Address - Phone:407-697-4277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0391994Medicaid
WI2521-43OtherPHARMACY LICENSE
HIPMP-1895OtherPHARMACY LICENSE
MDPO8489OtherPHARMACY LICENSE
NDPHAR1918OtherPHARMACY LICENSE
IN300033160Medicaid
MIVS0172399Medicaid
IL054.021498OtherPHARMACY LICENSE
UT12766690-1708OtherPHARMACY LICENSE
DEA9-0012676OtherPHARMACY LICENSE
KYIN2605OtherPHARMACY LICENSE
MTPHA-MOP-LIC-84404OtherPHARMACY LICENSE
ORRP-0003705OtherPHARMACY LICENSE
NC14929OtherPHARMACY LICENSE
MN266265OtherPHARMACY LICENSE
MEMO40003141OtherPHARMACY LICENSE
WYNR-51935OtherPHARMACY LICENSE
IANR5450OtherPHARMACY LICENSE
CT008107334Medicaid
VT036.0134601OtherPHARMACY LICENSE
NY038275OtherPHARMACY LICENSE
PA103759236Medicaid
SD400-2266OtherPHARMACY LICENSE
ID58582MSOtherPHARMACY LICENSE
NHNR2270OtherPHARMACY LICENSE
COOSP.0007488OtherPHARMACY LICENSE
CTPCN.0003825OtherPHARMACY LICENSE
PANP001573OtherPHARMACY LICENSE
NMPH0005403OtherPHARMACY LICENSE
FLPH33336OtherPHARMACY LICENSE
AZY008405OtherPHARMACY LICENSE
AK193819OtherPHARMACY LICENSE
NJ28RO00224700OtherPHARMACY LICENSE
WVMO0561538OtherPHARMACY LICENSE
VA0214002479OtherPHARMACY LICENSE
OH0240000154OtherPHARMACY LICENSE
MO2021001793OtherPHARMACY LICENSE
ID202190019Medicaid
MI5301012447OtherPHARMACY LICENSE
IN60006758AOtherPHARMACY LICENSE
GAPHNR001945OtherPHARMACY LICENSE