Active NPI
Costco Wholesale Corporation
- Community/Retail Pharmacy
- Chula Vista, CA
National Provider Identifier
1497865091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PHY42921
- Legal business name
- COSTCO WHOLESALE CORPORATION
- Practice address
- 895 E H St
Chula Vista, CA 91910 - Phone
- (619) 482-4405
- Fax
- (619) 656-5919
- NPI assigned
- Aug 30, 2006
- 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 | PHY42921 | CA | Primary |
Addresses
Primary practice location
895 E H St
Chula Vista, CA 91910
Mailing address
PO Box 34300
Seattle, WA 98124-1300
Phone (425) 313-6670
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PHA429210 | Medicaid | CA | |
| 0570021 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER |
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": "1156896000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1747785600000",
"number": "1497865091",
"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": "895 E H ST",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "91910",
"telephone_number": "619-482-4405",
"fax_number": "619-656-5919"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COSTCO WHOLESALE CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-30",
"last_updated": "2025-05-21",
"certification_date": "2025-05-21",
"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": "PHY42921",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PHA429210",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
"identifier": "0570021",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Chula Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 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.