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	332S00000X	Hearing Aid Equipment

General Provider Information

NPI Number	:	1487047494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COSTCO WHOLESALE CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 35005
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-3405
Country	:	US
Telephone Number	:	425-313-8100
Fax Number	:	425-313-6922

Provider Business Practice Location Address
First Line	:	340 LAKEWOOD CENTER MALL
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-2409
Country	:	US
Telephone Number	:	562-295-1530
Fax Number	:	562-295-1531

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CHRISTIAN ANTHIS
Credential	:
Telephone Number	:	425-427-3530

Provider Enumeration Date	:	03/16/2015
Last Update Date	:	03/16/2015

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