Healthcare Provider Details

I. General information

NPI: 1558478842
Provider Name (Legal Business Name): THE BARTELL DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 22ND AVE NW
SEATTLE WA
98107
US

IV. Provider business mailing address

4025 DELRIDGE WAY SW #400
SEATTLE WA
98106
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 NumberCF00000051
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberCF
License Number StateWA

VIII. Authorized Official

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