Provider Demographics
NPI:1558728006
Name:COSTCO WHOLESALE CORPORATION
Entity Type:Organization
Organization Name:COSTCO WHOLESALE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:AMOY
Authorized Official - Last Name:PEART
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:345-559-9619
Mailing Address - Street 1:4646 BRONX BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1449
Mailing Address - Country:US
Mailing Address - Phone:347-559-9619
Mailing Address - Fax:
Practice Address - Street 1:4646 BRONX BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1449
Practice Address - Country:US
Practice Address - Phone:347-559-9619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI0578843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy