NPIMap

Organization Active NPI

Costco Wholesale Corporation

  • Community/Retail Pharmacy
  • Traverse City, MI
National Provider Identifier
1154840346
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
COSTCO WHOLESALE CORPORATION
Practice address
125 E South Airport Rd
Traverse City, MI 49686
Phone
(231) 252-7010
Fax
(231) 252-7001
NPI assigned
Sep 19, 2017
Organization subpart
Yes
Parent organization
COSTCO WHOLESALE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 22, 2025

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 MI Primary

Addresses

Primary practice location

125 E South Airport Rd
Traverse City, MI 49686

Mailing address

PO Box 34300
Seattle, WA 98124-1300
Phone (231) 252-7000

Other names 1

  • Costco Pharmacy #1279 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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2286093Costco Pharmacy #1279125 E S Airport Road, Traverse City, MI 49686Certificate of waiverJul 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Costco Pharmacy 3021,506 organizations share this tax ID, including this one
Part of
Costco Pharmacy 302

Organizations with this tax ID in the same state 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1505779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747872000000",
    "number": "1154840346",
    "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": "231-252-7000",
            "fax_number": "231-252-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 E SOUTH AIRPORT RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49686",
            "telephone_number": "231-252-7010",
            "fax_number": "231-252-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTCO WHOLESALE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COSTCO WHOLESALE CORPORATION",
        "enumeration_date": "2017-09-19",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "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": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Costco Pharmacy #1279",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Costco Pharmacy #1279",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.