1619087228 NPI number — COSTCO WHOLESALE CORPORATION

Table of content: (NPI 1619087228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619087228 NPI number — COSTCO WHOLESALE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COSTCO WHOLESALE CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619087228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-1300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-313-6670
Provider Business Mailing Address Fax Number:
425-313-6595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10921 CAUSEWAY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANDON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-952-0102
Provider Business Practice Location Address Fax Number:
813-952-0109
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CURTIS
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP PHARMACY
Authorized Official Telephone Number:
425-313-7206

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH17575 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1091254 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 115715200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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