38D2216202 CLIA NUMBER - CREDENA HEALTH PHARMACY TANASBOURNE

Laboratory Demographics

  • CLIA Code: 38D2216202
  • Facility Name: CREDENA HEALTH PHARMACY TANASBOURNE
  • Facility Address: 10670 NE CORNELL RD, STE 102
    HILLSBORO, OR
    ZIP 97124
  • Facility Phone: 503 216-9020
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIKA KUSUMA
  • NPI Number: 1265708812
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D2216202
LAB Type Pharmacy
Facility Name CREDENA HEALTH PHARMACY TANASBOURNE
Street 10670 NE CORNELL RD, STE 102
City HILLSBORO
State OR
ZIP 97124
Phone 503 216-9020
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/10/2025
Certificate Expiration Date 3/9/2027
Facility Type Pharmacy
Lab Director DANIKA KUSUMA

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This page was last updated on: 3/20/2025