Costco Pharmacy # 1002

LBN: Costco Wholesale Corporation
Costco Pharmacy # 1002 is an health care organization with primary practice located at 2201 Verne Roberts Cir , Antioch CA 94509-7911. The organization recently has only one registered license in Suppliers / Community/Retail Pharmacy, which is considered as the primary health care specialty. Costco Wholesale Corporation can be contacted via phone (925) 470-4612, or through Mastromonica, Michael via phone (425) 313-2892.

Contact Information

Primary practice address
2201 Verne Roberts Cir Antioch CA 94509-7911
Phone: (925) 470-4612
Fax: (925) 470-4609
Website:
Map and Directions
Authorized official contact:
Name: Mastromonica, Michael
Phone: (425) 313-2892

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X PHY41246 California

Profile Details

NPI number 1043320641
LBN Legal business name Costco Wholesale Corporation
DBA Doing business as Costco Pharmacy # 1002
Authorized official Mastromonica, Michael
Entity Organization
Organization subpart 1 No
Enumeration date Aug 30th, 2006
Last updated Aug 19th, 2014 - about 12 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043320641 NPPES
Other 0566438 NCPDP PROVIDER IDENTIFICATION NUMBER

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