Basic Information
| Provider Information | |||||||||
| NPI: | 1528178159 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COSTCO WHOLESALE CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34300 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253136670 | ||||||||
| FaxNumber: | 4253136595 | ||||||||
| Practice Location | |||||||||
| Address1: | 835 N 3050 E | ||||||||
| Address2: | |||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4352560002 | ||||||||
| FaxNumber: | 4352560009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | CURTIS | ||||||||
| AuthorizedOfficialFirstName: | VICTOR | ||||||||
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| AuthorizedOfficialTitleorPosition: | SVP PHARMACY | ||||||||
| AuthorizedOfficialTelephone: | 4253137206 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | 48078511703 | UT | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 4693568 | 01 | NCPDP PROVIDER IDENTIFICATION NUMBER | OTHER |