Provider Demographics
NPI:1609837178
Name:BARTELL DRUG
Entity Type:Organization
Organization Name:BARTELL DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY
Authorized Official - Phone:425-895-0044
Mailing Address - Street 1:14004 NE 86TH CT
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-1957
Mailing Address - Country:US
Mailing Address - Phone:425-895-0044
Mailing Address - Fax:
Practice Address - Street 1:14004 NE 86TH CT
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-1957
Practice Address - Country:US
Practice Address - Phone:425-995-0044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00012501183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty