NPIMap

Organization Active NPI

Credena Health LLC

Doing business as Credena Health Pharmacy Fullerton

  • Community/Retail Pharmacy
  • Fullerton, CA
National Provider Identifier
1952048712
Registry record updated Mar 16, 2024
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 Fullerton
Practice address
1950 Sunny Crest Dr Ste 1200
Fullerton, CA 92835-3639
Phone
(714) 449-4850
NPI assigned
May 13, 2022
Last updated
Mar 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2024

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
Community/Retail Pharmacy 3336C0003X NU Primary
Specialty Pharmacy 3336S0011X NU

Addresses

Primary practice location

1950 Sunny Crest Dr Ste 1200
Fullerton, CA 92835-3639

Mailing address

PO Box 2704
Portland, OR 97208-2704

Other names 1

  • CREDENA HEALTH PHARMACY FULLERTON Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20200831003396 CA Part B Supplier - Pharmacy 7810207206 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Burbank, CA; Fullerton, CA; Orange, CA; Tarzana, CA
O20201001001343 CA Part B Supplier - Mass Immunization (Roster Biller Only) 7810207206 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Burbank, CA; Fullerton, CA; Orange, CA; Tarzana, CA
O20230524000751 CA DME Supplier - Pharmacy 7810207206 Practice locations: Fullerton, CA

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Credena Health Pharmacy Fullerton1950 Sunny Crest Dr, Fullerton, CA 92835-3639(714) 449-4850 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

NPI Registry JSON

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

{
    "created_epoch": "1652400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710547200000",
    "number": "1952048712",
    "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": "1950 SUNNY CREST DR STE 1200",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353639",
            "telephone_number": "714-449-4850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREDENA HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-13",
        "last_updated": "2024-03-16",
        "certification_date": "2024-03-16",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CREDENA HEALTH PHARMACY FULLERTON",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CREDENA HEALTH PHARMACY FULLERTON",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fullerton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2024; 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.