Active NPI
Costco Wholesale Corporation
Doing business as Costco Pharmacy #1101
- Community/Retail Pharmacy
- Pewaukee, WI
National Provider Identifier
1245512664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 9098-42
- Legal business name
- COSTCO WHOLESALE CORPORATION
- Doing business as
- Costco Pharmacy #1101
- Practice address
- 443 Pewaukee Rd
Pewaukee, WI 53072 - Phone
- (262) 956-6701
- Fax
- (262) 956-6702
- NPI assigned
- Sep 12, 2011
- Last updated
- Feb 7, 2024
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 9098-42 | WI | Primary |
Addresses
Primary practice location
443 Pewaukee Rd
Pewaukee, WI 53072
Mailing address
PO Box 34300
Seattle, WA 98124
Other names 1
- Costco Pharmacy #1101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080820000449 | TX | Part B Supplier - Centralized Flu Biller | 4082679451 | This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315785600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1707264000000",
"number": "1245512664",
"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": "98124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "443 PEWAUKEE RD",
"city": "PEWAUKEE",
"state": "WI",
"postal_code": "53072",
"telephone_number": "262-956-6701",
"fax_number": "262-956-6702"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COSTCO WHOLESALE CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2011-09-12",
"last_updated": "2024-02-07",
"certification_date": "2024-02-07",
"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": "WI",
"license": "9098-42",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Costco Pharmacy #1101",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Pewaukee, WI
- Hubert A Cios, M.D.
- Kelsey Lynne Cobler
- Sheryl Lynn Conrad
- Jeffrey Miles Coppage, M.D.
- Jessica Dawn Marie Corey, LPC
- Costco Wholesale Corporation (Costco Hearing Aid #1101)
- Costco Wholesale Corporation (Costco Optical #1101)
- Judith Marie Crabb, NCC, LPC
- Cubic Life Integrative Care S.C.
- Kirsten Cull, NP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 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.