Costco Wholesale Corporation
Organization Active NPI Community/Retail Pharmacy · West Bountiful, UT
NPI 1619087244 · NPPES record last updated May 21, 2025
Key facts
- NPI
- 1619087244
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 60392771703 (UT)
- Legal business name
- COSTCO WHOLESALE CORPORATION
- Practice address
- 573 W 100 N
West Bountiful, UT 84010 - Phone
- (801) 299-3968
- Fax
- (801) 299-3965
- NPI assigned
- Aug 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Richard Stephens
- Title
- SVP Pharmacy
- Phone
- (425) 313-8259
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 60392771703 | UT | Yes |
Addresses
Primary practice location
573 W 100 N
West Bountiful, UT 84010
Mailing address
PO Box 34300
Seattle, WA 98124-1300
Phone (425) 313-6670
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4610362 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER |
Other providers in West Bountiful, UT
- Clark Joseph Ellison Beck
- Amber Brown
- Devin Butler
- Jennifer Chase
- Costco Wholesale Corporation
- Rachel Cottle
- Todd A Gardner
- April Michelle Gray
- Maren Hansen
- Erika Susanne Hardy
All providers in West Bountiful, UT · Community/Retail Pharmacy in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.