| NPI | 1164809778 |
|---|---|
| Doing Business As | CREDENA HEALTH PHARMACY LAKESHORE |
| Entity Type | Organization |
| Authorized Contact | MIKE SKAFI A VP/Secretary 575-650-3396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2023-12-07 |