Provider Demographics
NPI:1053815977
Name:COSTCO WHOLESALE CORPORATION
Entity Type:Organization
Organization Name:COSTCO WHOLESALE CORPORATION
Other - Org Name:COSTCO PHARMACY #1317
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-313-7206
Mailing Address - Street 1:PO BOX 34300
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1300
Mailing Address - Country:US
Mailing Address - Phone:425-313-8100
Mailing Address - Fax:
Practice Address - Street 1:5030 HAMNER AVE.
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752
Practice Address - Country:US
Practice Address - Phone:951-749-7192
Practice Address - Fax:951-749-7183
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COSTCO WHOLESALE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-23
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy