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General NPI Number Information
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NPI Number | 1740516830
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Entity Type | Organization
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Legal Business Name | COSTCO
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 2100 DR MARTIN LUTHER KING JUNIOR PKWY
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City | CHICO
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State | CA
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Zip | 95928-4422
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Country | US
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Telephone | 530-342-3776
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Fax | 530-332-1746
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Provider Business Mailing Address
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Address Line | 2100 DR MARTIN LUTHER KING JUNIOR PKWY
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City | CHICO
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State | CA
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Zip | 95928-4422
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Country | US
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Telephone | 530-342-3776
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Fax | 530-332-1746
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. CLINT COOK
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Credential | RPH
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Telephone | 530-342-3776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | RPH32394
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License Number State | CA
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