CREDENA HEALTH LLC (NPI# 1164809778) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164809778 |
| Entity Type | Organization |
| Organization Name | CREDENA HEALTH LLC |
| Other Organization Name | CREDENA HEALTH PHARMACY LAKESHORE |
| Practice Address |
50331a Us Highway 93 Polson MT 59860-7046 |
| Mailing Address |
Po Box 5936b Portland OR 97228-5436 |
| Practice Telephone | 4068830342 |
| Practice Fax Number | 4068830469 |
| Mailing Telephone | 4068838447 |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2020-01-24 |
| Authorized Official Name | DONALD WAYNE ANDERSON JR. (DIRECTOR REIMBURSEMENT ADMIN) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2151758 | 01 |
| Other Name | Type Code |
|---|---|
| Credena Health Pharmacy Lakeshore | Doing Business As Name - Organization |
| Providence Lakeshore Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346850641 | Credena Health LLC | Pharmacy | 1510 Division St Ste 110, Oregon City, OR 97045-1572 | 2020-08-03 |
| 1629618186 | Credena Health LLC | Durable Medical Equipment & Medical Supplies | 3300 Providence Dr Ste 101, Anchorage, AK 99508-4619 | 2020-01-13 |
| 1578049631 | Credena Health LLC | Pharmacy | 4805 Ne Glisan St Ste 11n321, Portland, OR 97213 | 2018-07-12 |
| 1396125399 | Credena Health LLC | Pharmacy | 6348 Ne Halsey St, Suite A, Portland, OR 97213-4720 | 2015-06-04 |
| 1124358239 | Credena Health LLC | Pharmacy | 501 S Buena Vista St Fl 1, Burbank, CA 91505 | 2010-01-12 |
| 1225190408 | Credena Health LLC | Pharmacy | 9155 Sw Barnes Rd Ste 102, Portland, OR 97225-6625 | 2006-12-14 |
| 1568551430 | Credena Health LLC | Pharmacy | 101 W 8th Ave Ste 207653, Spokane, WA 99204 | 2006-10-11 |
| 1235243668 | Credena Health LLC | Pharmacy | 5050 Ne Hoyt St Ste 142, Portland, OR 97213-2956 | 2006-08-19 |
| 1205811601 | Credena Health LLC | Pharmacy | 1140 West La Veta, Orange, CA 92868-3849 | 2005-12-08 |
| 1447249909 | Credena Health LLC | Pharmacy | 19200 N Kelsey Street, Monroe, WA 98272 | 2005-10-18 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | Credena Health LLC | 6348 Ne Halsey St, Suite A, Portland, OR 97213 |
| Iowa Business Entities | CREDENA HEALTH LLC | 6348 Ne Halsey St. Suite A, Portland, OR 97213 |
| Oregon Corporations, Companies and Business Names | CREDENA HEALTH LLC | 6348 Ne Halsey Street, Suite A, Portland, OR 97213 |
| Washington State Corporations | CREDENA HEALTH LLC | 6348 Ne Halsey St, Suite A, Portland, OR 97213-4720 |
| Street Address |
50331A US HIGHWAY 93 |
| City | POLSON |
| State | MT |
| Zip Code | 59860-7046 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679095020 | Ashley J Gilham | Registered Nurse | #5 4th Ave E., Polson, MT 59860 | 2017-07-07 |
| 1225585532 | St. Luke Community Hospital | Clinic/Center | 107 Ridgewater Dr., Polson, MT 59860 | 2016-09-02 |
| 1306202163 | Western Montana Mental Health Center | Community Based Residential Treatment Facility, Mental Illness | 7 13th Ave East, Polson, MT 59860 | 2016-01-11 |
| 1154730364 | Wanda L King | Dietitian, Registered | 6 Thirteenth Avenue East, Poslon, MT 59860 | 2014-08-13 |
| 1104255637 | Dacia Lee Antiste-fisher | Counselor | #5 4th Ave. E., Polson, MT 59860 | 2013-11-05 |
| 1154758134 | Richard Pierre | Pharmacy Technician | 5 4th Ave E., Polson, MT 59860 | 2013-10-04 |
| 1154755197 | Wal-mart Stores, Inc | Durable Medical Equipment & Medical Supplies | 36318 Memory Lane, Polson, MT 59860 | 2013-08-27 |
| 1245582022 | Catherine D Addison | Registered Nurse | 5 4th Ave. East, Polson, MT 59860 | 2012-10-04 |
| 1114220787 | Erika Ann Weber | Social Worker | #5 4th Ave. E, Polson, MT 59860 | 2010-12-21 |
| 1942431473 | Lisa L. Scalpane | Counselor | 803 Main Street, Suite C, Polson, MT 59860 | 2009-07-31 |
| Find all providers in zip 59860 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386657070 | Bundy Management Inc. | Pharmacy | One 7th Ave East, Suite D, Polson, MT 59860 | 2006-08-14 |
| 1073687919 | Credena Health LLC | Pharmacy | 6 13th Ave E, Polson, MT 59860-5315 | 2006-11-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023630662 | Pharm406 Inc | Pharmacy | 1410 38th St W Ste A, Billings, MT 59102-7552 | 2020-05-16 |
| 1710521679 | Billmont Rx, LLC | Pharmacy | 1603 Grand Ave Ste 250, Billings, MT 59102-3000 | 2019-11-04 |
| 1235636689 | Daniel Patrick Doran | Pharmacy | 590 Stockett Rd, Sand Coulee, MT 59472-9745 | 2018-04-11 |
| 1477069193 | 406 Rx Pllc | Pharmacy | 117 N Main St Ste A, Three Forks, MT 59752-9013 | 2017-12-18 |
| 1508385477 | Jkw & Jira Inc. | Pharmacy | 1245 N 29th St Ste 100, Billings, MT 59101 | 2017-09-12 |
| 1326564857 | Billings Clinic Specialty Supplies and Services, LLC | Pharmacy | 1015 Broadwater Ave Ste 101, Billings, MT 59102 | 2017-08-16 |
| 1679977433 | Superior Specialty Pharmacy of Montana, LLC | Pharmacy | 20 Four Mile Dr Ste 4, Kalispell, MT 59901-2644 | 2014-10-22 |
| 1134439797 | Kc Western Drug | Pharmacy | 105 E 1st, Clyde Park, MT 59018-0000 | 2010-10-18 |
| 1669795647 | Broadus Foods, Inc | Pharmacy | 120 S Park Avenue, Broadus, MT 59317-0549 | 2010-03-05 |
| 1316135940 | Rosauers Supermarkets Inc | Pharmacy | 3255 Technology Blvd W, Bozeman, MT 59718-6854 | 2007-10-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.