Costco Wholesale Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

RTP.021236200-03 Issued in OH

Legal business name

COSTCO WHOLESALE CORPORATION

Doing business as

Costco Pharmacy
Costco Pharmacy #1632

Practice address

7135 Veterans Blvd
Liberty Township, OH 45069-3771

Phone

(513) 346-7940

NPI assigned

Aug 30, 2006

Last updated

Nov 9, 2022By 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 2

Addresses

Other identifiers 1

Other names 2

• COSTCO PHARMACY Doing business as
• Costco Pharmacy #1632 Doing business as

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": "1667952000000",
    "number": "1861502494",
    "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": "7135 VETERANS BLVD",
            "city": "LIBERTY TOWNSHIP",
            "state": "OH",
            "postal_code": "450693771",
            "telephone_number": "513-346-7940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTCO WHOLESALE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "RTP.021236200-03",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2077691",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COSTCO PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Costco Pharmacy #1632",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Heather Ann Connor, LISW
• Fred A Contant
• Dena Grace Costa, M.D.
• Costco Wholesale Corporation (Costco Hearing Aid #1632)
• Costco Wholesale Corporation (Costco Optical #1632)
• Gina Couch
• Jennifer Cox, RPH
• Sydney Ellen Cox
• Linda G Craft, LISW
• Michelle Lynn Craig

• Community/Retail Pharmacy in Liberty Township, OH
• Providers in Liberty Township, OH by specialty
• Community/Retail Pharmacy in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2022; 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.