{
"Npi": {
"NPI": "1649721051",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COSTCO WHOLESALE CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 379",
"SecondLineMailingAddress": "170 COOLEY MESA ROAD",
"MailingAddressCityName": "GYPSUM",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "81637-0379",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "970-328-7610",
"MailingAddressFaxNumber": "970-328-7607",
"FirstLinePracticeLocationAddress": "170 COOLEY MESA ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GYPSUM",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "81637",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "970-328-7610",
"PracticeLocationAddressFaxNumber": "970-328-7607",
"EnumerationDate": "10/20/2016",
"LastUpdateDate": "08/03/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CULLEN",
"AuthorizedOfficialFirstName": "DANIEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACY MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "970-328-7610",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "21340",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}