Healthcare Provider Details

I. General information

NPI: 1134500838
Provider Name (Legal Business Name): COSTCO WHOLESALE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
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: 805-578-3309
Mailing address:
  • Phone: 805-578-3305
  • Fax: 805-578-3309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number46620
License Number StateCA

VIII. Authorized Official

Name: RICHARD STEPHENS
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 425-313-8259