Organization
COSTCO WHOLESALE CORPORATION
Active
Other names
Costco Pharmacy #1108
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD STEPHENS (SVP)
(425) 313-8259
Entity
Organization
Contact information
Practice address
1501 W KELLY AVE, PHARR, TX 78577
(956) 354-3901
(956) 354-3902
Mailing address
PO BOX 34300, SEATTLE, WA 98124-1300
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
27802
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5905180
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/15/2012
Last updated
05/14/2024
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