Costco Wholesale Corporation
Organization Active NPI Community/Retail Pharmacy · Pewaukee, WI
NPI 1245512664 · NPPES record last updated Feb 7, 2024
Key facts
- NPI
- 1245512664
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 9098-42 (WI)
- Legal business name
- COSTCO WHOLESALE CORPORATION
- Practice address
- 443 Pewaukee Rd
Pewaukee, WI 53072 - Phone
- (262) 956-6701
- Fax
- (262) 956-6702
- NPI assigned
- Sep 12, 2011
- Organization subpart
- No
Authorized official
- Name
- Richard Stephens
- Title
- SVP Pharmacy
- Phone
- (425) 313-8259
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 9098-42 | WI | Yes |
Addresses
Primary practice location
443 Pewaukee Rd
Pewaukee, WI 53072
Mailing address
PO Box 34300
Seattle, WA 98124
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5132840 | Other | NCPDP |
Other names
- Costco Pharmacy #1101
Other providers in Pewaukee, WI
- Hubert A Cios
- Kelsey Lynne Cobler
- Sheryl Lynn Conrad
- Jeffrey Miles Coppage
- Jessica Dawn Marie Corey
- Costco Wholesale Corporation
- Costco Wholesale Corporation
- Judith Marie Crabb
- Cubic Life Integrative Care S.C.
- Kirsten Cull
All providers in Pewaukee, WI · Community/Retail Pharmacy in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.