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	3336C0003X	Community/Retail Pharmacy	28RS00467300	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3133232	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1629188248
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	:	425-313-6670
Fax Number	:	425-313-6595

Provider Business Practice Location Address
First Line	:	20 BRIDEWELL PL
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07014
Country	:	US
Telephone Number	:	973-779-0189
Fax Number	:	973-779-0717

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	05/22/2025

Similar Medicare Providers

1356342588 — EVGENI GORIOUNOV D.D.S.
Practice Location Address:

139 MAIN AVE
CLIFTON, NJ
07014-1707

Practice Phone: 973-471-8300
Practice Fax: 973-471-6662

1730111626 — STOP AND SHOP SUPERMARKET CO LLC
Practice Location Address:

160 KINGSLAND RD
CLIFTON, NJ
07014-1915

Practice Phone: 973-779-7831
Practice Fax: 973-779-5245

1265454888 — NEW JERSEY CVS PHARMACY LLC
Practice Location Address:

30 KINGSLAND RD
CLIFTON, NJ
07014-1904

Practice Phone: 973-330-0003
Practice Fax: 973-330-0003

1538276506 — DR. LOREN JESSE SCHNEIDER DPM
Practice Location Address:

341 SOUTH PARKWAY
CLIFTON, NJ
07014

Practice Phone: 973-779-1614
Practice Fax: 860-647-0449

1356432173 — MICHAL R FRUCHTER
Practice Location Address:

475 SOUTH PKWY
CLIFTON, NJ
07014-1244

Practice Phone: 973-249-8107
Practice Fax:

1922179530 — DR. JERRY SANDERS D.C.
Practice Location Address:

539 PASSAIC AVE
CLIFTON, NJ
07014-1211

Practice Phone: 973-473-2066
Practice Fax: 973-473-6399

Directions to “COSTCO WHOLESALE CORPORATION ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.