Credena Health Pharmacy Centralia – Community/Retail Pharmacy, NPI 1124117056

Credena Health Pharmacy Centralia is a healthcare provider. based in Portland, Oregon. specializing in Community/Retail Pharmacy. The organization holds a License No. PHAR.CF.60659119 (WA). The NPI Number for Credena Health Pharmacy Centralia is 1124117056

Main info

Organization
Name
Credena Health Pharmacy Centralia
NPI
1124117056
Phone
Not provided
Address
PO BOX 2704
Authorized Official
MIKE SKAFI AVP/SECRETARY
Enumeration Date
11 October 2006
Last Update Date
31 May 2024
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience72
Completeness80
Years active:19State licenses:1Digital endpointsUpdated within 12 months

Provider Addresses for Credena Health Pharmacy Centralia

  • PO BOX 2704

    PORTLAND, OR 972082704

    Phone:

    Type: Mailing

  • 1800 COOKS HILL RD STE P

    CENTRALIA, WA 985319162

    Phone: (360) 827-7997

    Type: Location

  • 2001 LIND AVE SW

    RENTON, WA 980573303

    Phone:

    Type: Mailing

  • PO BOX 5936B

    PORTLAND, OR 972289027

    Phone: (360) 827-7997

    Fax: (360) 330-8579

    Type: Mailing

  • Providence Centralia Hospital, 914, South Scheuber Road, Centralia, Lewis County, Washington, 98331, United States

    CENTRALIA, WA 985319027

    Phone: (360) 330-8564

    Fax: (360) 330-8525

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2020-12-30

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Past revalidation due date

Earliest CMS due date was 2023-12-31 (895 days ago).

Enrollment records

1

Earliest due date

2023-12-31

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20201230001663OPharmacyWA2023-12-31

What to do next

  • Verify current status on the CMS Revalidation Lookup Tool immediately.
  • Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
  • Overdue revalidation can lead to deactivation of Medicare billing privileges.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 97208)

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Reviews

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Frequently asked questions

How do I look up Credena Health Pharmacy Centralia by NPI?
Use NPI 1124117056 when you need to reference Credena Health Pharmacy Centralia in forms, claims, or directories.
Is Credena Health Pharmacy Centralia active in the national directory?
Credena Health Pharmacy Centralia's public NPI profile is in an active state.
What does Credena Health Pharmacy Centralia treat or focus on?
Patients typically see Credena Health Pharmacy Centralia under the specialty Community/Retail Pharmacy. Clinical services aligned with this taxonomy classification.
What location metadata exists for Credena Health Pharmacy Centralia?
The page summarizes Portland, Oregon for Credena Health Pharmacy Centralia; expand the address list for detail.
Is Credena Health Pharmacy Centralia a real provider?
This page reflects official NPPES data for NPI 1124117056. Always confirm identity and privileges with the practice and licensing boards.

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