Costco Wholesale Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

50639 Issued in CA

Legal business name

COSTCO WHOLESALE CORPORATION

Doing business as

Costco Pharmacy # 1091

Practice address

2680 Reynolds Ranch Pkwy
Lodi, CA 95240-6848

Phone

(209) 366-7301

Fax

(209) 366-7302

NPI assigned

May 2, 2011

Last updated

May 27, 2025By 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

Avp Pharmacy

Phone

(425) 313-8259

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• COSTCO PHARMACY # 1091 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": "1304294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748304000000",
    "number": "1922399419",
    "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": "2680 REYNOLDS RANCH PKWY",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952406848",
            "telephone_number": "209-366-7301",
            "fax_number": "209-366-7302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTCO WHOLESALE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-02",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "AVP PHARMACY",
        "authorized_official_telephone_number": "425-313-8259"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "50639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5640900",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COSTCO PHARMACY # 1091",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ariel Rene Correa, MS, CCC-SLP
• Benita Paula Cortez
• Martie J Coryell, MFT
• Costco Wholesale Corporation (Costco Optical #1091)
• Costco Wholesale Corporation (Costco Hearing Aid #1091)
• Jesus David Covarrubias
• Covenant Care Lodi, LLC (Arbor Rehabilitation & Nursing Center)
• Covenant Care Lodi, LLC (Arbor Place)
• Kiana Lee Nicole Cox, MD
• Hannah Renee Cronin, RT1431260226

• Community/Retail Pharmacy in Lodi, CA
• Providers in Lodi, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.

Verify at the official NPI Registry.