NPIMap

Organization Active NPI

Credena Health LLC

Doing business as Credena Health Pharmacy Lakeshore

  • Community/Retail Pharmacy
  • Polson, MT
National Provider Identifier
1164809778
Registry record updated Aug 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
CREDENA HEALTH LLC
Doing business as
Credena Health Pharmacy Lakeshore
Practice address
50331A US Highway 93
Polson, MT 59860-7046
Phone
(406) 883-0342
Fax
(406) 883-0469
NPI assigned
May 4, 2015
Last updated
Aug 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mike Skafi
Title
Avp/Secretary
Phone
(575) 650-3396

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

50331A US Highway 93
Polson, MT 59860-7046

Mailing address

PO Box 2704
Portland, OR 97208-2704

Other identifiers 1

IdentifierTypeStateIssuer
2151758OtherPK

Other names 1

  • Credena Health Pharmacy Lakeshore Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20191104002892 MT Part B Supplier - Mass Immunization (Roster Biller Only) 7810207206 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Polson, MT; Missoula, MT
O20191114000809 MT Part B Supplier - Pharmacy 7810207206 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Missoula, MT; Polson, MT
O20210112002086 MT DME Supplier - Pharmacy 7810207206 Practice locations: Polson, MT

Other NPIs with the same Medicare PAC ID 19

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 19

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
27D2314100Credena Health Pharmacy Lakeshore50331 US Hwy 93, Polson, MT 59860Certificate of waiverNov 12, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Credena Health LLC50331 US Hwy 93, Polson, MT 59860-7046(406) 883-0342 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Oct 22, 2015

National Provider Directory

National Provider Directory
Tax ID family
Credena Health LLC21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

11 17th Ave E
Polson, MT 59860
Phone (406) 883-1011

50331 US Highway 93
Ste A
Polson, MT 59860
Phone (406) 883-0342

Practitioners & affiliated clinicians

Practitioners 117

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 117

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785974400000",
    "number": "1164809778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2704",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972082704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50331A US HIGHWAY 93",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598607046",
            "telephone_number": "406-883-0342",
            "fax_number": "406-883-0469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREDENA HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-04",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A",
        "authorized_official_last_name": "SKAFI",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "AVP/SECRETARY",
        "authorized_official_telephone_number": "575-650-3396"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2151758",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Credena Health Pharmacy Lakeshore",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Credena Health Pharmacy Lakeshore",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Polson, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.