Active NPI
Costco Wholesale Corporation
- Community/Retail Pharmacy
- San Diego, CA
National Provider Identifier
1588774194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PHY39751
- Legal business name
- COSTCO WHOLESALE CORPORATION
- Practice address
- 4605 Morena Blvd
San Diego, CA 92117 - Phone
- (858) 581-4550
- Fax
- (858) 581-4424
- 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 | PHY39751 | CA | Primary |
Addresses
Primary practice location
4605 Morena Blvd
San Diego, CA 92117
Mailing address
PO Box 34300
Seattle, WA 98124-1300
Phone (425) 313-6670
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PHA397510 | Medicaid | CA | |
| 0589854 | 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 DirectoryLocations
4605 Morena Blvd
San Diego, CA 92117
Phone (858) 270-4400
NPI 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": "1747699200000",
"number": "1588774194",
"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": "4605 MORENA BLVD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92117",
"telephone_number": "858-581-4550",
"fax_number": "858-581-4424"
}
],
"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": "PHY39751",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PHA397510",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
"identifier": "0589854",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- 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.