Healthcare Provider Details

I. General information

NPI: 1255414397
Provider Name (Legal Business Name): COSTCO WHOLESALE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16505 SIERRA LAKES PKWY
FONTANA CA
92336
US

IV. Provider business mailing address

PO BOX 34300
SEATTLE WA
98124-1300
US

V. Phone/Fax

Practice location:
  • Phone: 909-770-5648
  • Fax: 909-770-5645
Mailing address:
  • Phone: 425-313-6670
  • Fax: 425-313-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY48304
License Number StateCA

VIII. Authorized Official

Name: RICHARD STEPHENS
Title or Position: SVP PHARMACY
Credential:
Phone: 425-313-8259