Healthcare Provider Details

I. General information

NPI: 1013090562
Provider Name (Legal Business Name): BATES DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 N NEVADA ST
SPOKANE WA
99207-2968
US

IV. Provider business mailing address

3704 N NEVADA ST
SPOKANE WA
99207-2968
US

V. Phone/Fax

Practice location:
  • Phone: 509-489-4500
  • Fax: 509-489-4527
Mailing address:
  • Phone: 509-489-4500
  • Fax: 509-489-4527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00057208
License Number StateWA

VIII. Authorized Official

Name: ROBERT CORDIER
Title or Position: PRESIDENT CEO
Credential:
Phone: 509-489-4500