Costco Wholesale Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

48615 Issued in CA

Legal business name

COSTCO WHOLESALE CORPORATION

Practice address

2700 Park Ave
Tustin, CA 92782-2708

Phone

(714) 338-1942

Fax

(714) 338-1936

NPI assigned

May 7, 2007

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 # 1001 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": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748304000000",
    "number": "1114130002",
    "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": "2700 PARK AVE",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927822708",
            "telephone_number": "714-338-1942",
            "fax_number": "714-338-1936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTCO WHOLESALE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "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": "48615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5626809",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COSTCO PHARMACY # 1001",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "COSTCO PHARMACY # 1001",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katia Nicole Correa, PT
• Ernesto Cortes
• Stephanie Cortez, LCSW
• Cosmos Health Solutions, LLC
• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Katharine Costello, LMFT

• All providers in Tustin, CA
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.