NPIMap

Organization Active NPI

Credena Health LLC

  • Pharmacy
  • Anchorage, AK
National Provider Identifier
1760483556
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
CREDENA HEALTH LLC
Doing business as
Credena Health Pharmacy Anchorage
Practice address
3300 Providence Dr
Ste 101
Anchorage, AK 99508-4671
Phone
(907) 212-5090
Fax
(907) 212-5091
NPI assigned
Aug 3, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 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
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X Primary

Addresses

Primary practice location

3300 Providence Dr
Ste 101
Anchorage, AK 99508-4671

Mailing address

PO Box 2704
Portland, OR 97208-2704

Other identifiers 1

IdentifierTypeStateIssuer
0202072OtherAKNCPDP

Other names 1

  • Credena Health Pharmacy Anchorage Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200130000775 AK Part B Supplier - Mass Immunization (Roster Biller Only) 7810207206 Practice locations: Anchorage, AK
O20200131001703 AK Part B Supplier - Pharmacy 7810207206 Practice locations: Anchorage, AK

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

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

NPI Registry JSON

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1760483556",
    "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": "3300 PROVIDENCE DR",
            "address_2": "STE 101",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084671",
            "telephone_number": "907-212-5090",
            "fax_number": "907-212-5091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREDENA HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-03",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-08",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "0202072",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Credena Health Pharmacy Anchorage",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Credena Health Pharmacy Anchorage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.