Healthcare Provider Details

I. General information

NPI: 1073060976
Provider Name (Legal Business Name): THE BARTELL DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 22ND AVE NW
SEATTLE WA
98107-3119
US

IV. Provider business mailing address

4025 DELRIDGE WAY SW SUITE #400
SEATTLE WA
98106-1249
US

V. Phone/Fax

Practice location:
  • Phone: 206-783-3051
  • Fax: 206-784-9272
Mailing address:
  • Phone: 206-763-2626
  • Fax: 206-767-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHAR.CF.6065894
License Number StateWA

VIII. Authorized Official

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