Costco Wholesale Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

1846CP Issued in ID

Legal business name

COSTCO WHOLESALE CORPORATION

Doing business as

Costco Pharmacy 773

Practice address

355 E Neider Ave
Coeur D Alene, ID 83815

Phone

(208) 676-7353

Fax

(208) 676-7379

NPI assigned

Aug 30, 2006

Last updated

Nov 21, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Richard B Stephens

Title

SVP Pharmacy

Phone

(425) 313-8259

Specialties & licenses 1

Addresses

Other names 1

• Costco Pharmacy 773 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": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700524800000",
    "number": "1144330754",
    "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": "355 E NEIDER AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "83815",
            "telephone_number": "208-676-7353",
            "fax_number": "208-676-7379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTCO WHOLESALE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "B",
        "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": "ID",
            "license": "1846CP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Costco Pharmacy 773",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marin Selene Cordova, CRNA
• Core Chiropractic, PLLC
• Corene Alvarado
• Timothy Wayne Cork, CPRP, BS
• Mark Walter Cornelius, M.S., M.A. LCPC
• Costco Wholesale Corporation (Costco Optical # 773)
• Costco Wholesale Corporation (Costco Hearing Aid #773)
• Casey Lee Cotant, M.D.
• Jonathan Michael Cotteen, CRNA
• Tamara Coulson, MS

• Community/Retail Pharmacy in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Community/Retail Pharmacy in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.