Provider Demographics
NPI:1588772180
Name:THE BARTELL DRUG CO
Entity type:Organization
Organization Name:THE BARTELL DRUG CO
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:
Authorized Official - Phone:206-767-1371
Mailing Address - Street 1:4025 DELRIDGE WAY SW
Mailing Address - Street 2:STE 400
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1249
Mailing Address - Country:US
Mailing Address - Phone:206-767-1316
Mailing Address - Fax:206-767-1397
Practice Address - Street 1:6602 64TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4834
Practice Address - Country:US
Practice Address - Phone:360-658-5218
Practice Address - Fax:360-658-5549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WACF000563543336C0003X
WACF.00056354333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2110557OtherPK
WA0333520052Medicaid
WA6022321Medicaid
WA6022321OtherMEDICAID DME
WA0333520052Medicare NSC
WAP00070933OtherMEDICARE B RAILROAD