MEDICARE: THE BARTELL DRUG CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	CF00000053	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2107023	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083724769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BARTELL DRUG CO

Provider Business Mailing Address
First Line	:	4025 DELRIDGE WAY SW
Second Line	:	STE 400
City	:	SEATTLE
State	:	WA
Zip	:	98106-1249
Country	:	US
Telephone Number	:	206-767-1316
Fax Number	:	206-767-1397

Provider Business Practice Location Address
First Line	:	9600 15TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-2820
Country	:	US
Telephone Number	:	206-763-2728
Fax Number	:	206-762-7630

Authorized Official
Title or Position	:	SR VP OF PHARMACY
Name	:	PETER KOO
Credential	:
Telephone Number	:	206-763-2626

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/12/2016

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Directions to “THE BARTELL DRUG CO ” Practice Location

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