Provider Demographics
NPI:1538566401
Name:COSTCO
Entity type:Organization
Organization Name:COSTCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:HOANG
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-358-6950
Mailing Address - Street 1:2020 COMMERCE DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3246
Mailing Address - Country:US
Mailing Address - Phone:507-286-1870
Mailing Address - Fax:507-286-1861
Practice Address - Street 1:2020 COMMERCE DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3246
Practice Address - Country:US
Practice Address - Phone:507-286-1870
Practice Address - Fax:507-286-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1181283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy