Healthcare Provider Details

I. General information

NPI: 1881704401
Provider Name (Legal Business Name): COSTCO WHOLESALE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62207 NW COSTCO DR
BEND OR
97703-8508
US

IV. Provider business mailing address

PO BOX 34300
SEATTLE WA
98124-1300
US

V. Phone/Fax

Practice location:
  • Phone: 541-640-8582
  • Fax: 541-640-8573
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 Number0001290
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2078301
Identifier TypeOTHER
Identifier State
Identifier IssuerPK
# 2
Identifier3811204
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP IDENTIFICATION NUMBER

VIII. Authorized Official

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