=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326728684
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COSTCO WHOLESALE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2023
-----------------------------------------------------
Last Update Date | 11/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 SCARBOROUGH DOWNS RD
-----------------------------------------------------
City | SCARBOROUGH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04074-6589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-503-9912
-----------------------------------------------------
Fax | 207-503-9903
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 34300
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98124-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-416-2829
-----------------------------------------------------
Fax | 425-313-6595
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP PHARMACY
-----------------------------------------------------
Name | RICHARD STEPHENS
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 425-313-8259
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------