# COSTCO WHOLESALE CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Costco Pharmacy \#1696
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881704401
- **Authorized official:** RICHARD B STEPHENS (SVP PHARMACY)
- **Authorized official phone:** (425) 313-8259

## Contact information

- **Practice address:** 62207 NW COSTCO DR, BEND, OR 97703-8508
- **Practice address phone:** (541) 640-8582
- **Practice address fax:** (541) 640-8573
- **Mailing address:** PO BOX 34300, SEATTLE, WA 98124-1300
- **Mailing address phone:** (425) 313-6670
- **Mailing address fax:** (425) 313-6595

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 0001290 | OR | Yes |

## Other

- **Enumeration date:** 08/30/2006
- **Last updated:** 10/21/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2078301 | PK | — |
| 01 | — | 3811204 | NCPDP IDENTIFICATION NUMBER | — |