NPIMap

Organization Active NPI

Costco Wholesale Corporation

Doing business as Costco Pharmacy #1620

  • Community/Retail Pharmacy
  • Queen Creek, AZ
National Provider Identifier
1073250908
Registry record updated Nov 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
COSTCO WHOLESALE CORPORATION
Doing business as
Costco Pharmacy #1620
Practice address
20260 S. Ellsworth Rd
Queen Creek, AZ 85142
Phone
(480) 847-1010
Fax
(480) 847-1001
NPI assigned
May 12, 2022
Last updated
Nov 30, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
COSTCO WHOLESALE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Richard Stephens
Title
SVP Pharmacy
Phone
(425) 313-8259

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

20260 S. Ellsworth Rd
Queen Creek, AZ 85142

Mailing address

PO Box 34300
Seattle, WA 98124-1300
Phone (425) 313-8100

Other names 1

  • Costco Pharmacy #1620 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080820000449 TX Part B Supplier - Centralized Flu Biller 4082679451 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Costco Wholesale Corpor1,511 organizations share this tax ID, including this one
Part of
Costco Wholesale Corpor

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Locations

20260 S Ellsworth Rd
Queen Creek, AZ 85142
Phone (480) 847-1010

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701302400000",
    "number": "1073250908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34300",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241300",
            "telephone_number": "425-313-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20260 S. ELLSWORTH RD",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "85142",
            "telephone_number": "480-847-1010",
            "fax_number": "480-847-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTCO WHOLESALE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COSTCO WHOLESALE CORPORATION",
        "enumeration_date": "2022-05-12",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-30",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "SVP PHARMACY",
        "authorized_official_telephone_number": "425-313-8259"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Costco Pharmacy #1620",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Costco Pharmacy #1620",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Queen Creek, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.