Organization
COSTCO WHOLESALE CORPORATION
Active
Other names
Costco Pharmacy #1237
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD STEPHENS (AGMM THIRD PARTY)
(425) 313-8259
Entity
Organization
Contact information
Practice address
12515 PORTSIDE PKWY, LA VISTA, NE 68128-8224
(402) 378-7408
(402) 378-7399
Mailing address
PO BOX 34300, SEATTLE, WA 98124-1300
(425) 416-5259
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
678
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2163917
PK
—
Enumeration date
04/26/2016
Last updated
05/27/2025
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