Healthcare Provider Details

I. General information

NPI: 1942980974
Provider Name (Legal Business Name): COSTCO WHOLESALE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 10/13/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 COLLINA TERRACE
CLERMONT FL
34711-7204
US

IV. Provider business mailing address

PO BOX 34300
SEATTLE WA
98124-1300
US

V. Phone/Fax

Practice location:
  • Phone: 689-407-3673
  • Fax: 689-407-3664
Mailing address:
  • Phone: 254-416-2829
  • Fax: 425-313-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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