Organization Active NPI

Trinity Health Pharmacy Services, LLC

Specialty Pharmacy
Fort Wayne, IN

National Provider Identifier

1669016895

Registry record updated Apr 25, 2022

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
Practitioners & affiliated clinicians
NPI Registry JSON
Other providers in Fort Wayne, IN
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Specialty PharmacyTaxonomy code 3336S0011X
Legal business name: TRINITY HEALTH PHARMACY SERVICES, LLC
Practice address: 12279 Bluffton Road
Fort Wayne, IN 46809
Phone: (407) 697-4277
NPI assigned: Oct 31, 2019
Organization subpart: No

NPPES NPI Registry

Updated by the provider on Apr 25, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name: Damon Redding, PHARMD, MBANPI 1508867920
Title: VP and Chief Pharmacy Officer
Phone: (734) 343-7600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)	Code	Primary
Durable Medical Equipment & Medical Supplies	332B00000X
Pharmacy	333600000X
Community/Retail Pharmacy	3336C0003X
Mail Order Pharmacy	3336M0002X
Specialty Pharmacy	3336S0011X	Primary

Addresses

Primary practice location

12279 Bluffton Road
Fort Wayne, IN 46809

Mailing address

12279 Bluffton Road
Fort Wayne, IN 46809
Phone (734) 343-7600

Other identifiers 41

Identifier	Type	State	Issuer
0391994	Medicaid	OH
2521-43	Other	WI	PHARMACY LICENSE
PMP-1895	Other	HI	PHARMACY LICENSE
PO8489	Other	MD	PHARMACY LICENSE
PHAR1918	Other	ND	PHARMACY LICENSE
300033160	Medicaid	IN
VS0172399	Medicaid	MI
054.021498	Other	IL	PHARMACY LICENSE
12766690-1708	Other	UT	PHARMACY LICENSE
A9-0012676	Other	DE	PHARMACY LICENSE
IN2605	Other	KY	PHARMACY LICENSE
PHA-MOP-LIC-84404	Other	MT	PHARMACY LICENSE
RP-0003705	Other	OR	PHARMACY LICENSE
14929	Other	NC	PHARMACY LICENSE
266265	Other	MN	PHARMACY LICENSE
MO40003141	Other	ME	PHARMACY LICENSE
NR-51935	Other	WY	PHARMACY LICENSE
NR5450	Other	IA	PHARMACY LICENSE
008107334	Medicaid	CT
036.0134601	Other	VT	PHARMACY LICENSE
038275	Other	NY	PHARMACY LICENSE
103759236	Medicaid	PA
400-2266	Other	SD	PHARMACY LICENSE
58582MS	Other	ID	PHARMACY LICENSE
NR2270	Other	NH	PHARMACY LICENSE
OSP.0007488	Other	CO	PHARMACY LICENSE
PCN.0003825	Other	CT	PHARMACY LICENSE
NP001573	Other	PA	PHARMACY LICENSE
PH0005403	Other	NM	PHARMACY LICENSE
PH33336	Other	FL	PHARMACY LICENSE
Y008405	Other	AZ	PHARMACY LICENSE
193819	Other	AK	PHARMACY LICENSE
28RO00224700	Other	NJ	PHARMACY LICENSE
MO0561538	Other	WV	PHARMACY LICENSE
0214002479	Other	VA	PHARMACY LICENSE
0240000154	Other	OH	PHARMACY LICENSE
2021001793	Other	MO	PHARMACY LICENSE
202190019	Medicaid	ID
5301012447	Other	MI	PHARMACY LICENSE
60006758A	Other	IN	PHARMACY LICENSE
PHNR001945	Other	GA	PHARMACY LICENSE

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment: Enrolled in IN

Enrollment records 1

Enrollment ID	State	Provider type	PAC ID	Details
O20200211000750	IN	Part B Supplier - Pharmacy	9436585486	Practice locations: Fort Wayne, IN

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Damon Gerard Redding, PHARM.D.
- Pharmacotherapy Pharmacist
- Atlanta, GA
- NPI 1508867920
NPD Authorized official
Zachary L Roberts, PHARMD
- Pharmacist
- Fort Wayne, IN
- NPI 1497038574
NPD

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650844800000",
    "number": "1669016895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12279 BLUFFTON ROAD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46809",
            "telephone_number": "734-343-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12279 BLUFFTON ROAD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46809",
            "telephone_number": "407-697-4277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY HEALTH PHARMACY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-31",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-25",
        "status": "A",
        "authorized_official_last_name": "REDDING",
        "authorized_official_first_name": "DAMON",
        "authorized_official_title_or_position": "VP AND CHIEF PHARMACY OFFICER",
        "authorized_official_telephone_number": "734-343-7600",
        "authorized_official_credential": "PHARMD, MBA"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0391994",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "2521-43",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "PMP-1895",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "PO8489",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "PHAR1918",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300033160",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "VS0172399",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "054.021498",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "12766690-1708",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "A9-0012676",
            "state": "DE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "IN2605",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "PHA-MOP-LIC-84404",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "RP-0003705",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "14929",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "266265",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "MO40003141",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "NR-51935",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "NR5450",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008107334",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "036.0134601",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "038275",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103759236",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "400-2266",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "58582MS",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "NR2270",
            "state": "NH"
        },
        {
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            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "OSP.0007488",
            "state": "CO"
        },
        {
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            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "PCN.0003825",
            "state": "CT"
        },
        {
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            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "NP001573",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
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            "identifier": "PH0005403",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "PH33336",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "Y008405",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "193819",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "28RO00224700",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "MO0561538",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "0214002479",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "0240000154",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "2021001793",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202190019",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "5301012447",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "60006758A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "PHNR001945",
            "state": "GA"
        }
    ],
    "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 Apr 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.