Provider Demographics
NPI:1306144431
Name:COSTCO WHOLESALE
Entity type:Organization
Organization Name:COSTCO WHOLESALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHARMACY
Authorized Official - Prefix:PROF
Authorized Official - First Name:THUY
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY
Authorized Official - Phone:650-988-7160
Mailing Address - Street 1:1000 N RENGSTORFF AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-1716
Mailing Address - Country:US
Mailing Address - Phone:650-988-7160
Mailing Address - Fax:
Practice Address - Street 1:1000 N. RENGSTORFF AVE.
Practice Address - Street 2:
Practice Address - City:MT. VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043
Practice Address - Country:US
Practice Address - Phone:650-988-7160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty