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General NPI Number Information
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NPI Number | 1578049631
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Entity Type | Organization
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Legal Business Name | CREDENA HEALTH LLC
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 4805 NE GLISAN ST STE 11N321
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City | PORTLAND
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State | OR
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Zip | 97213
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Country | US
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Telephone | 503-962-1700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2704
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City | PORTLAND
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State | OR
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Zip | 97208-2704
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AVP/SECRETARY
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Name | MIKE SKAFI
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Credential |
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Telephone | 575-650-3396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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