Provider Demographics
NPI:1053854372
Name:COSTCO WHOLESALE
Entity Type:Organization
Organization Name:COSTCO WHOLESALE
Other - Org Name:SAVE MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:VY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:916-850-1005
Mailing Address - Street 1:1800 CAVITT DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6235
Mailing Address - Country:US
Mailing Address - Phone:918-850-1005
Mailing Address - Fax:916-850-1023
Practice Address - Street 1:1800 CAVITT DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6235
Practice Address - Country:US
Practice Address - Phone:918-850-1005
Practice Address - Fax:916-850-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50675333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy