Provider Demographics
NPI:1437400744
Name:THE BARTELL DRUG COMPANY
Entity Type:Organization
Organization Name:THE BARTELL DRUG COMPANY
Other - Org Name:BARTELL DRUGS # CORPORATE OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP OF PHARMACY
Authorized Official - Prefix:MR
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:#400
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106
Mailing Address - Country:US
Mailing Address - Phone:206-763-2626
Mailing Address - Fax:206-767-1397
Practice Address - Street 1:4025 DELRIDGE WAY SW
Practice Address - Street 2:#400
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106
Practice Address - Country:US
Practice Address - Phone:206-763-2626
Practice Address - Fax:206-767-1371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy