MEDICARE: COSTCO WHOLESALE CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336M0002X	Mail Order Pharmacy

General Provider Information

NPI Number	:	1073079521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COSTCO WHOLESALE CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 34300
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1300
Country	:	US
Telephone Number	:	425-313-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 LOGISTICS AVE STE B
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-4672
Country	:	US
Telephone Number	:	800-607-6861
Fax Number	:	877-258-9584

Authorized Official
Title or Position	:	SVP/PHARMACY
Name	:	RICHARD STEPHENS
Credential	:
Telephone Number	:	425-313-8259

Provider Enumeration Date	:	02/20/2019
Last Update Date	:	02/17/2022

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Directions to “COSTCO WHOLESALE CORPORATION ” Practice Location

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