NPIMap

Organization Active NPI

Credena Health LLC

Doing business as Credena Health Pharmacy Olympia

  • Community/Retail Pharmacy
  • Olympia, WA
National Provider Identifier
1487696787
Registry record updated Dec 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHAR.CF.60658956 Issued in WA
Legal business name
CREDENA HEALTH LLC
Doing business as
Credena Health Pharmacy Olympia
Practice address
413 Lilly Rd NE
Mail Stop Llh10
Olympia, WA 98506-5133
Phone
(360) 493-7412
Fax
(360) 493-5403
NPI assigned
Jun 12, 2006
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHAR.CF.60658956 WA Primary

Addresses

Primary practice location

413 Lilly Rd NE
Mail Stop Llh10
Olympia, WA 98506-5133

Mailing address

PO Box 2704
Portland, OR 97208-2704
Phone (360) 493-7412

Other identifiers 1

IdentifierTypeStateIssuer
2106972OtherPK

Other names 1

  • Credena Health Pharmacy Olympia Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20191025002766 WA Part B Supplier - Pharmacy 7810207206 7 other NPIs on this enrollment
This NPI is an additional NPI on the 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
This NPI is an additional NPI on the enrollment
Practice locations: Centralia, WA; Colville, WA; Everett, WA; Olympia, WA; Seattle, WA; Spokane, WA
O20201230001439 WA DME Supplier - Pharmacy 7810207206 Practice locations: Olympia, 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.

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Credena Health LLC413 Lilly Rd NE, Olympia, WA 98506-5133(360) 493-7412 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

Locations

413 Lilly Rd NE
Stop LLH10
Olympia, WA 98506
Phone (360) 493-7412

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701734400000",
    "number": "1487696787",
    "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",
            "telephone_number": "360-493-7412",
            "fax_number": "360-493-5403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 LILLY RD NE",
            "address_2": "MAIL STOP LLH10",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065133",
            "telephone_number": "360-493-7412",
            "fax_number": "360-493-5403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREDENA HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "PHAR.CF.60658956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2106972",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Credena Health Pharmacy Olympia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olympia, 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.
  • 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.