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

General Provider Information

NPI Number	:	1891623989
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	:	425-416-2660
Fax Number	:	425-313-6595

Provider Business Practice Location Address
First Line	:	1915 W PARK PLACE BLVD
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087
Country	:	US
Telephone Number	:	333-666-5555
Fax Number	:	333-555-4444

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

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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Directions to “COSTCO WHOLESALE CORPORATION ” Practice Location

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