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Organization
CREDENA HEALTH LLC
Active
Organization
CREDENA HEALTH LLC
Active
Other names
CREDENA HEALTH PHARMACY TANASBOURNE
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE SKAFI (AVP/SECRETARY)
(575) 650-3396
Entity
Organization
Contact information
Practice address
10670 NE CORNELL RD STE 102, HILLSBORO, OR 97124-9221
(503) 216-9020
(503) 216-9029
Mailing address
PO BOX 2704, PORTLAND, OR 97208-2704
(503) 216-9020
(503) 216-9029
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
RP-0002694
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3844253
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/28/2012
Last updated
12/07/2023
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