Organization
COSTCO WHOLESALE CORPORATION
Active
Other names
Costco Pharmacy #621
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVE LOVELL RPH (PHARMACIST-IN-CHARGE)
(239) 433-7249
Entity
Organization
Contact information
Practice address
10088 GULF CENTER DR, FORT MYERS, FL 33913-8961
(239) 433-7249
Mailing address
10088 GULF CENTER DR, FORT MYERS, FL 33913-8961
(239) 433-7249
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
0202214057
VA
3336C0003X
Community/Retail Pharmacy
Primary
36031
SC
3336C0003X
Community/Retail Pharmacy
PS53638
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
699245
NABP
—
Enumeration date
09/09/2015
Last updated
09/09/2015
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