Costco Wholesale Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

27802 Issued in TX

Legal business name

COSTCO WHOLESALE CORPORATION

Doing business as

Costco Pharmacy #1108

Practice address

1501 W Kelly Ave
Pharr, TX 78577

Phone

(956) 354-3901

Fax

(956) 354-3902

NPI assigned

Feb 15, 2012

Last updated

May 14, 2024By 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 Stephens

Title

SVP

Phone

(425) 313-8259

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Costco Pharmacy #1108 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": "1329264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715644800000",
    "number": "1154694644",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 W KELLY AVE",
            "city": "PHARR",
            "state": "TX",
            "postal_code": "78577",
            "telephone_number": "956-354-3901",
            "fax_number": "956-354-3902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTCO WHOLESALE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-15",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "SVP",
        "authorized_official_telephone_number": "425-313-8259"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "27802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5905180",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Costco Pharmacy #1108",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jerry Eugene Cormier, APT; CRTS
• Shalom Yael Corona, SLP-INTERN
• Jesus E Corpus, EMT-LP, RN, MSN, FNP
• Eddie Cortes
• Costco Wholesale Corporation (Costco Optical #1108)
• Costco Wholesale Corporation (Costco Hearing Aid #1108)
• David William Coutcher, D.C.
• Creations Therapy Outpatient Rehab LLC
• Cross-Med EMS LLC
• Patricia Crossland, P.A.-C

• Community/Retail Pharmacy in Pharr, TX
• Providers in Pharr, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; 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.