Provider Demographics
NPI:1255448544
Name:THE BARTELL DRUG COMPANY
Entity type:Organization
Organization Name:THE BARTELL DRUG COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OPERATIONS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:R.
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-767-1375
Mailing Address - Street 1:4727 DENVER AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-2316
Mailing Address - Country:US
Mailing Address - Phone:206-767-1375
Mailing Address - Fax:206-767-1397
Practice Address - Street 1:424 BELLEVUE WAY NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5015
Practice Address - Country:US
Practice Address - Phone:425-454-3194
Practice Address - Fax:425-455-5163
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE BARTELL DRUG COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-24
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF000000573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6034102Medicaid
WA6034102OtherMEDICAID DME
WAP00070933OtherMEDICARE B RAILROAD
WA4902094OtherNCPDP
WA0333520014Medicare NSC
WAP00070933OtherMEDICARE B RAILROAD