NPIMap

Organization Active NPI

Costco Wholesale Corporation

Doing business as Costco Pharmacy #1209

  • Community/Retail Pharmacy
  • Menomonee Falls, WI
National Provider Identifier
1285011890
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
9338-42 Issued in WI
Legal business name
COSTCO WHOLESALE CORPORATION
Doing business as
Costco Pharmacy #1209
Practice address
9235 Pershing Avenue
Menomonee Falls, WI 53051
Phone
(262) 946-6070
Fax
(262) 946-6061
NPI assigned
May 4, 2015
Last updated
Feb 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

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)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 9338-42 WI Primary

Addresses

Primary practice location

9235 Pershing Avenue
Menomonee Falls, WI 53051

Mailing address

PO Box 3430
Seattle, WA 98114-3430

Other identifiers 1

IdentifierTypeStateIssuer
2153673OtherPK

Other names 1

  • Costco Pharmacy #1209 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080820000449 TX Part B Supplier - Centralized Flu Biller 4082679451 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Costco Wholesale Corpor1,511 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 19

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1430697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707264000000",
    "number": "1285011890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3430",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981143430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9235 PERSHING AVENUE",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "53051",
            "telephone_number": "262-946-6070",
            "fax_number": "262-946-6061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTCO WHOLESALE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-04",
        "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": "9338-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2153673",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Costco Pharmacy #1209",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Menomonee Falls, WI

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.

Verify at the official NPI Registry.