Provider Demographics
NPI:1154431831
Name:BARTELL DRUG CO
Entity type:Organization
Organization Name:BARTELL DRUG CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZOREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-975-5937
Mailing Address - Street 1:200 NEWBERRY CMNS
Mailing Address - Street 2:
Mailing Address - City:ETTERS
Mailing Address - State:PA
Mailing Address - Zip Code:17319-9363
Mailing Address - Country:US
Mailing Address - Phone:717-975-5937
Mailing Address - Fax:206-767-1397
Practice Address - Street 1:22833 BOTHELL EVERETT HWY
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9385
Practice Address - Country:US
Practice Address - Phone:425-481-7810
Practice Address - Fax:425-485-9179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
WACF000037633336C0003X
WACF.00003763333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0333520015Medicaid
2108789OtherPK
WA6008247Medicaid
WAP00070933OtherMEDICARE B RAILROAD
WA4920143OtherNCPDP
WA6008247Medicaid
4920143OtherOTHER ID NUMBER-COMMERCIAL NUMBER