# CREDENA HEALTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CREDENA HEALTH PHARMACY TANASBOURNE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265708812
- **Authorized official:** MIKE SKAFI (AVP/SECRETARY)
- **Authorized official phone:** (575) 650-3396

## Contact information

- **Practice address:** 10670 NE CORNELL RD STE 102, HILLSBORO, OR 97124-9221
- **Practice address phone:** (503) 216-9020
- **Practice address fax:** (503) 216-9029
- **Mailing address:** PO BOX 2704, PORTLAND, OR 97208-2704
- **Mailing address phone:** (503) 216-9020
- **Mailing address fax:** (503) 216-9029

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RP-0002694 | OR | Yes |

## Other

- **Enumeration date:** 03/28/2012
- **Last updated:** 12/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3844253 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |