38D2216207 CLIA NUMBER - CREDENA HEALTH PHARMACY ST VINCENT

Laboratory Demographics

  • CLIA Code: 38D2216207
  • Facility Name: CREDENA HEALTH PHARMACY ST VINCENT
  • Facility Address: 9155 SW BARNES MOB 2, FLOOR 1, SUITE 102
    PORTLAND, OR
    ZIP 97225
  • Facility Phone: 503 216-2630
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIKA KUSUMA
  • NPI Number: 1225190408
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D2216207
LAB Type Pharmacy
Facility Name CREDENA HEALTH PHARMACY ST VINCENT
Street 9155 SW BARNES MOB 2, FLOOR 1, SUITE 102
City PORTLAND
State OR
ZIP 97225
Phone 503 216-2630
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: 9/29/2025