Costco Wholesale Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2656 Issued in AZ

Legal business name

COSTCO WHOLESALE CORPORATION

Doing business as

Costco Pharmacy
Costco Pharmacy #674

Practice address

17550 N 79TH Ave
Glendale, AZ 85308-8711

Phone

(623) 776-4002

Fax

(623) 776-4021

NPI assigned

Aug 30, 2006

Last updated

Nov 30, 2023By 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

Phone

(425) 313-8259

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• COSTCO PHARMACY Doing business as
• Costco Pharmacy #674 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701302400000",
    "number": "1396855995",
    "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": "17550 N 79TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088711",
            "telephone_number": "623-776-4002",
            "fax_number": "623-776-4021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTCO WHOLESALE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-30",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "SVP",
        "authorized_official_telephone_number": "425-313-8259"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AZ",
            "license": "2656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1989731",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COSTCO PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Costco Pharmacy #674",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dana Costanzo
• Costco Wholesale Corporation (Costco Optical #674)
• Costco Wholesale Corporation (Costco Hearing Aid #674)
• Chloe Cotnerwhipple
• Marco Antonio Cotto
• Carly Cottrell, M.S. CCC-SLP

• Community/Retail Pharmacy in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Community/Retail Pharmacy in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; 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.