Organization
COSTCO WHOLESALE CORPORATION
Active
Other names
Costco Pharmacy #1121
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD STEPHENS (SVP PHARMACY)
(425) 313-8259
Entity
Organization
Contact information
Practice address
2850 HOEPKER RD, SUN PRAIRIE, WI 53590
(608) 825-4011
(608) 825-4002
Mailing address
PO BOX 34300, SEATTLE, WA 98124-1300
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
9171-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5133335
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/30/2012
Last updated
02/07/2024
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