Costco Wholesale Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY48311 Issued in CA

Legal business name

COSTCO WHOLESALE CORPORATION

Doing business as

Costco Pharmacy #638

Practice address

79795 Highway 111
La Quinta, CA 92253-4756

Phone

(760) 342-0656

Fax

(760) 775-0367

NPI assigned

Oct 23, 2006

Last updated

May 27, 2025By 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

Avp Pharmacy

Phone

(425) 313-8259

Specialties & licenses 1

Addresses

Other names 1

• COSTCO PHARMACY #638 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748304000000",
    "number": "1164505202",
    "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": "79795 HIGHWAY 111",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922534756",
            "telephone_number": "760-342-0656",
            "fax_number": "760-775-0367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTCO WHOLESALE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "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": "PHY48311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COSTCO PHARMACY #638",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Consumerhealth, Inc. (Newport Dental - La Quinta (ORTHO))
• Raeann L Coombs
• Carol Sue Cornell, LCSW
• Teri Cortland, PSYD
• Marquita Eleanor Cosentino Murrietta
• Costco Wholesale Corporation (Costco Optical #638)
• Costco Wholesale Corporation (Costco Hearing Aid #638)
• County of Riverside (TAY Desert Drop-In)
• Graciela Cristerna, FNP
• Patricia Cruz Reyes, M.D.

• Community/Retail Pharmacy in La Quinta, CA
• Providers in La Quinta, 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 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.