Healthcare Provider Details

I. General information

NPI: 1073621785
Provider Name (Legal Business Name): THE BARTELL DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12946 SE KENT KANGLEY RD
KENT WA
98030-7940
US

IV. Provider business mailing address

4025 DELRIDGE WAY SW STE 400
SEATTLE WA
98106-1249
US

V. Phone/Fax

Practice location:
  • Phone: 253-631-6874
  • Fax: 253-631-7131
Mailing address:
  • Phone: 206-767-1316
  • Fax: 206-767-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00003803
License Number StateWA

VIII. Authorized Official

Name: PETER KOO
Title or Position: SR VP OF PHARMACY
Credential:
Phone: 206-763-2626