Provider Demographics
NPI:1326158007
Name:THE BARTELL DRUG CO
Entity Type:Organization
Organization Name:THE BARTELL DRUG CO
Other - Org Name:BARTELL DRUGS #62
Other - Org Type:Doing Business As
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:206-763-2626
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 1:18420 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4416
Practice Address - Country:US
Practice Address - Phone:206-542-2948
Practice Address - Fax:206-542-4865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WACF000582693336C0003X
WACF.00058269333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2108583OtherPK
WA6028476Medicaid
4931475OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WA4931475OtherNCPCP
WAP00070933OtherMEDICARE B RAILROAD
WA0333520063Medicare NSC
0333520063Medicare PIN