Provider Demographics
NPI:1801225636
Name:COSTCO
Entity Type:Organization
Organization Name:COSTCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARAMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARKS
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:540-338-2704
Mailing Address - Street 1:19193 PINTAIL CT
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3957
Mailing Address - Country:US
Mailing Address - Phone:540-338-2704
Mailing Address - Fax:
Practice Address - Street 1:19193 PINTAIL CT
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3957
Practice Address - Country:US
Practice Address - Phone:540-338-2704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty