MEDICARE: CREDENA HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	333600000X	Pharmacy
2	3336C0002X	Clinic Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1235243668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREDENA HEALTH LLC

Provider Business Mailing Address
First Line	:	PO BOX 2704
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-2704
Country	:	US
Telephone Number	:	503-215-6296
Fax Number	:	503-215-6459

Provider Business Practice Location Address
First Line	:	5050 NE HOYT ST STE 142
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-2956
Country	:	US
Telephone Number	:	503-215-6296
Fax Number	:	503-215-6459

Authorized Official
Title or Position	:	AVP/SECRETARY
Name	:	MIKE SKAFI
Credential	:
Telephone Number	:	575-650-3396

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	12/07/2023

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Directions to “CREDENA HEALTH LLC ” Practice Location

Language	Start Address	Practice Location

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