Active NPI
Sherwin O Davis, PHARMD
- Pharmacist
- Fort Wayne, IN
National Provider Identifier
1639475890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26023453A
- Practice address
- 10170 Illinois Rd
Fort Wayne, IN 46804-5774 - Phone
- (260) 436-6021
- NPI assigned
- Feb 7, 2011
- Last updated
- Dec 10, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26023453A | IN | Primary |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 26023453A | IN |
Addresses
Primary practice location
10170 Illinois Rd
Fort Wayne, IN 46804-5774
Mailing address
2400 E Center St
Warsaw, IN 46580-3817
Phone (260) 579-8854
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26023453A | IN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pharmaplus LLC | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pharmacy
- Fort Wayne, IN
- NPI 1609620764
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- Home Health Agency
- Fort Wayne, IN
- NPI 1033884838
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733788800000",
"number": "1639475890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 E CENTER ST",
"city": "WARSAW",
"state": "IN",
"postal_code": "465803817",
"telephone_number": "260-579-8854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10170 ILLINOIS RD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468045774",
"telephone_number": "260-436-6021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "SHERWIN",
"middle_name": "O",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-02-07",
"last_updated": "2024-12-10",
"certification_date": "2024-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26023453A",
"primary": true
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "IN",
"license": "26023453A",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.