Costco Wholesale Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY44956 Issued in CA

Legal business name

COSTCO WHOLESALE CORPORATION

Doing business as

COSTCO PHARMACY #475

Practice address

1600 El Camino Real
South San Francisco, CA 94080-1206

Phone

(650) 757-3002

Fax

(650) 757-3009

NPI assigned

Sep 5, 2006

Organization subpart

No

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

Authorized official

Name

Richard Stephens

Title

Avp Pharmacy

Phone

(425) 313-8259

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• COSTCO PHARMACY #475 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748390400000",
    "number": "1073615472",
    "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": "425-313-6670",
            "fax_number": "425-313-6595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 EL CAMINO REAL",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940801206",
            "telephone_number": "650-757-3002",
            "fax_number": "650-757-3009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTCO WHOLESALE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "AVP PHARMACY",
        "authorized_official_telephone_number": "425-313-8259"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY44956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0596835",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COSTCO PHARMACY #475",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stella Obligacion Coronado
• Luciana Danila Corral
• Samantha Cortez, AMFT
• Christina T Corzine, LCSW
• Kaitilyn Cosino
• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Costco Wholesale Corporation

• Community/Retail Pharmacy in South San Francisco, CA
• Providers in South San Francisco, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; 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.