Healthcare Provider Details

I. General information

NPI: 1285984468
Provider Name (Legal Business Name): COSTCO PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 PARK CENTER DR
SIMI VALLEY CA
93065-6207
US

IV. Provider business mailing address

2660 PARK CENTER DR
SIMI VALLEY CA
93065-6207
US

V. Phone/Fax

Practice location:
  • Phone: 805-578-3305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number55044
License Number StateCA

VIII. Authorized Official

Name: BARRY MAIZEL
Title or Position: REGIONAL PHARMACY SUPERVISOR
Credential:
Phone: 714-741-7726