Provider Demographics
NPI:1013090562
Name:BATES DRUG STORE INC
Entity Type:Organization
Organization Name:BATES DRUG STORE INC
Other - Org Name:BATES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-489-4500
Mailing Address - Street 1:3704 N NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2968
Mailing Address - Country:US
Mailing Address - Phone:509-489-4500
Mailing Address - Fax:509-489-4527
Practice Address - Street 1:3704 N NEVADA ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2968
Practice Address - Country:US
Practice Address - Phone:509-489-4500
Practice Address - Fax:509-489-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
WACF000572083336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2107952OtherPK
WA6088801Medicaid
WA6088801Medicaid