Healthcare Provider Details

I. General information

NPI: 1922181478
Provider Name (Legal Business Name): BATES DRUG STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 N NEVADA ST STE B
SPOKANE WA
99207-2968
US

IV. Provider business mailing address

3704 N NEVADA ST STE B
SPOKANE WA
99207-2968
US

V. Phone/Fax

Practice location:
  • Phone: 509-489-4500
  • Fax: 509-489-4330
Mailing address:
  • Phone: 509-489-4500
  • Fax: 509-489-4330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberCF00057935
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

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