Provider Demographics
NPI:1770842536
Name:COSTCO PHARMACY 218
Entity Type:Organization
Organization Name:COSTCO PHARMACY 218
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:703-406-7046
Mailing Address - Street 1:21398 PRICE CASCADES PLAZA
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164
Mailing Address - Country:US
Mailing Address - Phone:703-406-7048
Mailing Address - Fax:703-406-7045
Practice Address - Street 1:21398 PRICE CASCADES PLAZA
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164
Practice Address - Country:US
Practice Address - Phone:703-406-7048
Practice Address - Fax:703-406-7045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010260261QC1500X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care