=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538566401
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COSTCO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2014
-----------------------------------------------------
Last Update Date | 11/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 COMMERCE DR NW
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-3246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-286-1870
-----------------------------------------------------
Fax | 507-286-1861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2020 COMMERCE DR NW
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-3246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-286-1870
-----------------------------------------------------
Fax | 507-286-1861
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | PHIL HOANG VO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 507-358-6950
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 118128
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------