Organization
COSTCO WHOLESALE CORPORATION
Active
Other names
Costco Pharmacy #1222
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD STEPHENS (SVP PHARMACY)
(425) 313-7825
Entity
Organization
Contact information
Practice address
5401 W INTEGRITY WAY, GRAND CHUTE, WI 54913
(920) 363-7010
(920) 363-7001
Mailing address
PO BOX 34300, SEATTLE, WA 98124-1300
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
9346-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2153719
PK
—
Enumeration date
07/17/2015
Last updated
02/07/2024
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