Costco

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

051295396 Issued in IL

Legal business name

COSTCO

Practice address

25901 N Riverwoods Rd
Mettawa, IL 60045-3403

Phone

(847) 235-1302

NPI assigned

Oct 11, 2014

Last updated

Oct 11, 2014By 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

Dr. Angela Lee, PHARM.D.NPI 1497151658

Title

Pharmacist

Phone

(773) 988-2479

Specialties & licenses 1

Addresses

Tax ID family

Costco3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Costco

  • Public Health or Welfare Agency
  • Greenville, SC
  • NPI 1043635709
  NPD tax ID
• Costco

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Frederick, MD
  • NPI 1366827933
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Angela Lee, PHARM.D.

  • Pharmacist
  • Mettawa, IL
  • NPI 1497151658
  NPD (past) Authorized official

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

{
    "created_epoch": "1412985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412985600000",
    "number": "1164826772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1224 INVERRARY LN",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600153612",
            "telephone_number": "773-988-2479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25901 N RIVERWOODS RD",
            "city": "METTAWA",
            "state": "IL",
            "postal_code": "600453403",
            "telephone_number": "847-235-1302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTCO",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-11",
        "last_updated": "2014-10-11",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "773-988-2479",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "IL",
            "license": "051295396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Marie Ball, O.D.
• Costco Wholesale Corporation
• Costco Wholesale Corporation (Costco Optical #1074)
• Costco Wholesale Corporation (Costco Hearing Aid #1074)
• Dawn Kaplan, O.D.
• Mudra J Kapoor, MD

• Health Service Clinic/Center in Mettawa, IL
• Providers in Mettawa, IL by specialty
• Health Service Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.