NPIMap

Organization Active NPI

Credena Health LLC

Doing business as Credena Health Pharmacy Monroe

  • Community/Retail Pharmacy
  • Monroe, WA
National Provider Identifier
1447249909
Registry record updated Dec 5, 2023
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 Monroe
Practice address
19200 N Kelsey Street
Monroe, WA 98272
Phone
(360) 794-5555
Fax
(360) 805-4797
NPI assigned
Oct 18, 2005
Last updated
Dec 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2023

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
Pharmacy 333600000X NU
Clinic Pharmacy 3336C0002X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

19200 N Kelsey Street
Monroe, WA 98272

Mailing address

PO Box 2704
Portland, OR 97208-2704

Other identifiers 1

IdentifierTypeStateIssuer
2108111OtherPK

Other names 1

  • Credena Health Pharmacy Monroe Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191025002766 WA Part B Supplier - Pharmacy 7810207206 7 other NPIs on this enrollment
Practice locations: Centralia, WA; Colville, WA; Everett, WA; Olympia, WA; Seattle, WA; Spokane, WA
O20191101000859 WA Part B Supplier - Mass Immunization (Roster Biller Only) 7810207206 7 other NPIs on this enrollment
Practice locations: Centralia, WA; Colville, WA; Everett, WA; Olympia, WA; Seattle, WA; Spokane, WA

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 7

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

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701734400000",
    "number": "1447249909",
    "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": "19200 N KELSEY STREET",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "98272",
            "telephone_number": "360-794-5555",
            "fax_number": "360-805-4797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREDENA HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-18",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-04",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic 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": "2108111",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Credena Health Pharmacy Monroe",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Credena Health Pharmacy Monroe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.