Costco Wholesale Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

46909 Issued in CA

Legal business name

COSTCO WHOLESALE CORPORATION

Practice address

1130 Broadway
Chula Vista, CA 91911

Phone

(619) 205-1528

Fax

(619) 205-1525

NPI assigned

Aug 30, 2006

Last updated

May 20, 2025By 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

Richard Stephens

Title

SVP Pharmacy

Phone

(425) 313-8259

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747699200000",
    "number": "1306956958",
    "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": "1130 BROADWAY",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "91911",
            "telephone_number": "619-205-1528",
            "fax_number": "619-205-1525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTCO WHOLESALE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "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": "CA",
            "license": "46909",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5614258",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Derya Jim Coskun, MD
• Andrea B. Costa
• Vivianny Costa
• Costco Wholesale Corporation (Costco Optical #460)
• Costco Wholesale Corporation (Costco Hearing Aid #781)
• Costco Wholesale Corporation
• Costco Wholesale Corporation (Costco Optical #781)
• Costco Wholesale Corporation (Costco Hearing Aid #460)
• Yara Alessandra Cota Moreno
• Alexis Cota

• Community/Retail Pharmacy in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 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.