# COSTCO WHOLESALE CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Costco Pharmacy \#1222
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902280092
- **Authorized official:** RICHARD STEPHENS (SVP PHARMACY)
- **Authorized official phone:** (425) 313-7825

## Contact information

- **Practice address:** 5401 W INTEGRITY WAY, GRAND CHUTE, WI 54913
- **Practice address phone:** (920) 363-7010
- **Practice address fax:** (920) 363-7001
- **Mailing address:** PO BOX 34300, SEATTLE, WA 98124-1300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 9346-42 | WI | Yes |

## Other

- **Enumeration date:** 07/17/2015
- **Last updated:** 02/07/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2153719 | PK | — |