COSTCO WHOLESALE CORPORATION (NPI# 1073895496) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073895496 |
| Entity Type | Organization |
| Organization Name | COSTCO WHOLESALE CORPORATION |
| Other Organization Name | COSTCO PHARMACY # 1102 |
| Practice Address |
825 Cabela Dr Augusta GA 30909-8202 |
| Mailing Address |
Po Box 34300 Seattle WA 98124-1300 |
| Practice Telephone | 7067391701 |
| Practice Fax Number | 7067391702 |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2014-08-18 |
| Authorized Official Name | MICHAEL MASTROMONICA (AVP PHARMACY) |
| Authorized Official Telephone | 4253132892 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
PHRE009787 | GA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP PROVIDER IDENTIFICATION NUMBER | 1161734 | 01 | |
| PK | 2131887 | 01 |
| Other Name | Type Code |
|---|---|
| COSTCO Pharmacy # 1102 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982217345 | Costco Wholesale Corporation | Pharmacy | 2002 N. Neil St., Champaign, IL 61820 | 2020-08-26 |
| 1356954713 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 650 Garden Park Blvd, Cherry Hill, NJ 08002 | 2020-08-26 |
| 1609488378 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 4816 Bay City Rd, Midland, MI 48642 | 2020-08-23 |
| 1710599485 | Costco Wholesale Corporation | Pharmacy | 16261 S Boulevard Pl, Plainfield, IL 60586-4400 | 2020-08-23 |
| 1043838584 | Costco Wholesale Corporation | Pharmacy | 3403 W Chinden Blvd, Meridian, ID 83646-7151 | 2020-07-10 |
| 1316564628 | Costco Wholesale Corporation | Pharmacy | 16385 W Waddell Rd, Surprise, AZ 85388-9623 | 2020-07-02 |
| 1265054324 | Costco Wholesale Corporation | Pharmacy | 2495 E Lincoln Rd, Idaho Falls, ID 83401-2203 | 2020-05-12 |
| 1265072292 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 700 Highland Colony Pkwy, Ridgeland, MS 39157-8701 | 2020-01-07 |
| 1275183568 | Costco Wholesale Corporation | Hearing Aid Equipment | 995 Blue Gentian Rd, Eagan, MN 55121-1542 | 2019-09-18 |
| 1124675228 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 284 Flanders Rd, East Lyme, CT 06333-1710 | 2019-08-22 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | COSTCO WHOLESALE CORPORATION | 999 Lake Dr, Issaquah, WA 98027 |
| Washington State Corporations | COSTCO WHOLESALE CORPORATION | 999 Lake Dr, Issaquah, WA 98027-8990 |
| Colorado Business Entities | COSTCO WHOLESALE CORPORATION | 999 Lake Dr, Issaquah, WA 98027 |
| Iowa Business Entities | COSTCO WHOLESALE CORPORATION | 999 Lake Dr, Issaquah, WA 98027 |
| Vermont Business Registrations | COSTCO WHOLESALE CORPORATION | 999 Lake Drive, Issaquah, WA 98027 |
| New York State Corporations | COSTCO WHOLESALE CORPORATION | 28 Liberty St., New York, New York 10005 |
| Massachusetts Corporations | COSTCO WHOLESALE CORPORATION | 999 Lake Drive, Issaquah, WA 98027 |
| Connecticut Business Registrations | COSTCO WHOLESALE CORPORATION | 999 Lake Drive, Issaquah, WA 98027 |
| Virginia Business Entities | COSTCO WHOLESALE CORPORATION | 999 Lake Drive, Issaquah, Washington 98027 |
| Street Address |
825 CABELA DR |
| City | AUGUSTA |
| State | GA |
| Zip Code | 30909-8202 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275928111 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 825 Cabela Dr, Augusta, GA 30909-8202 | 2015-03-30 |
| 1528451150 | Costco Wholesale Corporation | Hearing Aid Equipment | 825 Cabela Dr, Augusta, GA 30909-8202 | 2015-03-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912513888 | Lauran Simpson | Behavior Technician | 1237 Augusta West Parkway, Augusta, GA 30909 | 2020-09-16 |
| 1487273884 | Still Perspectives Counseling LLC | Counselor | 1265 Inerstate Prwy, Suite B, Augusta, GA 30909 | 2020-04-15 |
| 1598397838 | Mjra Medical LLC | Psychologist | 3675 J Dewey Gray Cr Ste 300, Augusta, GA 30909 | 2020-02-05 |
| 1003452319 | Danny Robinson | Counselor | 2609 Commons Boulevard, Augusta, GA 30909 | 2019-11-21 |
| 1407498637 | Candice M Cruse | Social Worker | 2609 Commons Blvd, Augusta, GA 30909 | 2019-10-09 |
| 1902363385 | Mary D Jodon | Pharmacist | 3338 Wrightsboro Rd., Augusta, GA 30909 | 2019-02-21 |
| 1447790514 | Burn Critical Care Associates, LLC | Internal Medicine | 3614 J. Dewey Gray Circle, Bldg B., Augusta, GA 30909 | 2017-03-08 |
| 1124561766 | Sasha Latara Mccraw | Counselor | 7303 Palomino Court, Augusta, GA 30909 | 2016-11-30 |
| 1174974620 | Warren Umansky, Ph.d. | Psychologist | 302 Wheeler Executive Ctr, Augusta, GA 30909 | 2016-06-27 |
| 1811358955 | Theodora Mcleskey | Nurse Practitioner | 1215 George C. Wilson Drive, Augusta, GA 30909 | 2016-03-17 |
| Find all providers in zip 30909 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033716915 | Au Medical Center, Inc. | Pharmacy | 818 Saint Sebastian Way Ste 402, Augusta, GA 30901-2654 | 2020-10-05 |
| 1699308114 | Au Medical Center, Inc. | Pharmacy | 1014 Moore Avenue, Augusta, GA 30912-0001 | 2020-02-13 |
| 1891161246 | Gabiga-jordan LLC | Pharmacy | 4046 Jimmie Dyess Pkwy Ste 100, Augusta, GA 30909-9468 | 2015-08-19 |
| 1962803775 | Bryant and Newsome LLC | Pharmacy | 215 Furys Ferry Rd, Augusta, GA 30907-4718 | 2014-09-11 |
| 1467732701 | Medex Associates LLC | Pharmacy | 811 13th St Ste 10, Augusta, GA 30901-2771 | 2011-08-18 |
| 1598068967 | Clinical Specialties, LLC | Pharmacy | 318 Baston Rd, Suite 103, Augusta, GA 30907-2978 | 2010-12-07 |
| 1972789311 | Cvs State Capital LLC | Pharmacy | 119 Crossing Way, Augusta, ME 04330-6102 | 2008-01-16 |
| 1184727547 | Georgia Cvs Pharmacy LLC | Pharmacy | 2902 Peach Orchard Rd, Augusta, GA 30906-3504 | 2006-09-07 |
| 1255434072 | Georgia Cvs Pharmacy LLC | Pharmacy | 2559 Windsor Spring Rd, Augusta, GA 30906-4642 | 2006-09-07 |
| 1881639706 | Walgreen Co | Pharmacy | 3228 Wrightsboro Rd, Augusta, GA 30909-2937 | 2006-06-17 |
| Find all providers in AUGUSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.