=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467998765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COSTCO WHOLESALE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2017
-----------------------------------------------------
Last Update Date | 08/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 HALEAKALA HIGHWAY
-----------------------------------------------------
City | KAHULUI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-871-8755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 540 HALEAKALA HWY
-----------------------------------------------------
City | KAHULUI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96732-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-871-8755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | DR. MICHAEL BENJAMIN LASKO
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 808-446-6057
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------