Provider Demographics
NPI:1356451033
Name:THE BARTELL DRUG CO
Entity Type:Organization
Organization Name:THE BARTELL DRUG CO
Other - Org Name:BARTELL DRUGS #11
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 1:4344 UNIVERSITY WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5809
Practice Address - Country:US
Practice Address - Phone:206-632-3514
Practice Address - Fax:206-632-7362
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
WACF000000553336C0003X
WACF333600000X
WACF.00003763333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2107018OtherPK
WA0333520016Medicaid
WA6033708Medicaid
WA0333520016Medicare NSC
WA6033708OtherMEDICAID DME
WA6033708Medicaid
4906256OtherOTHER ID NUMBER-COMMERCIAL NUMBER