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	2002022725	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2634651	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1730299355
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	:	4200 RUSTY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128
Country	:	US
Telephone Number	:	314-894-7952
Fax Number	:	314-894-7973

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

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Directions to “COSTCO WHOLESALE CORPORATION ” Practice Location

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