Provider Demographics
NPI:1366835993
Name:COSTCO WHOLESALE CORPORATION
Entity Type:Organization
Organization Name:COSTCO WHOLESALE CORPORATION
Other - Org Name:COSTCO HEARING AID #1058
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-427-3530
Mailing Address - Street 1:PO BOX 35005
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3405
Mailing Address - Country:US
Mailing Address - Phone:425-313-8100
Mailing Address - Fax:425-313-6922
Practice Address - Street 1:4570 E CACTUS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7702
Practice Address - Country:US
Practice Address - Phone:480-308-7068
Practice Address - Fax:480-308-7070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COSTCO WHOLESALE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBHAD6297332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment