Provider Demographics
NPI:1013305036
Name:THE BARTELL DRUG COMPANY
Entity type:Organization
Organization Name:THE BARTELL DRUG COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VP OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:206-763-2626
Mailing Address - Street 1:4025 DELRIDGE WAY SW STE 400
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1273
Mailing Address - Country:US
Mailing Address - Phone:206-763-2626
Mailing Address - Fax:
Practice Address - Street 1:5529 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4102
Practice Address - Country:US
Practice Address - Phone:206-763-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF.605246263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACF.60524626OtherWASHINGTON PHARMACY LICENSE
WACF.60524626OtherWASHINGTON PHARMACY LICENSE