Provider Demographics
NPI:1013906528
Name:CREDENA HEALTH LLC
Entity Type:Organization
Organization Name:CREDENA HEALTH LLC
Other - Org Name:CREDENA HEALTH PHARMACY EVERETT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP/ SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SKAFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-650-3396
Mailing Address - Street 1:PO BOX 2704
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1321 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1665
Practice Address - Country:US
Practice Address - Phone:425-261-3555
Practice Address - Fax:425-261-3560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2108622OtherPK
WA6007967Medicaid