Costco Wholesale Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY48311 Issued in CA

Legal business name

COSTCO WHOLESALE CORPORATION

Practice address

79795 Highway 111
La Quinta, CA 92253-4756

Phone

(760) 342-0656

Fax

(760) 775-0367

NPI assigned

Oct 23, 2006

Organization subpart

No

Name

Richard Stephens

Title

Avp Pharmacy

Phone

(425) 313-8259

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

• COSTCO PHARMACY #638 Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 27, 2025.

{
    "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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5624259",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COSTCO PHARMACY #638",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Consumerhealth, Inc.
• Raeann L Coombs
• Carol Sue Cornell, LCSW
• Teri Cortland, PSYD
• Marquita Eleanor Cosentino Murrietta
• Costco Wholesale Corporation
• Costco Wholesale Corporation
• County of Riverside
• Graciela Cristerna, FNP
• Patricia Cruz Reyes, M.D.

• All providers in La Quinta, 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.