=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275643884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COSTCO WHOLESALE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 05/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1890 S UNIVERSITY DR
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-236-7837
-----------------------------------------------------
Fax | 954-236-7846
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 34300
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98124-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-313-6670
-----------------------------------------------------
Fax | 425-313-6595
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP PHARMACY
-----------------------------------------------------
Name | RICHARD STEPHENS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 425-313-8259
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH11692
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------