Costco Pharmacy # 1091

LBN: Costco Wholesale Corporation
Costco Pharmacy # 1091 is an health care organization with primary practice located at 2680 Reynolds Ranch Pkwy , Lodi CA 95240-6848. 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 (209) 366-7301, or through Mastromonica, Michael via phone (425) 313-2892.

Contact Information

Primary practice address
2680 Reynolds Ranch Pkwy Lodi CA 95240-6848
Phone: (209) 366-7301
Fax: (209) 366-7302
Website:
Map and Directions
Authorized official contact:
Name: Mastromonica, Michael
Phone: (425) 313-2892

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X 50639 California

Profile Details

NPI number 1922399419
LBN Legal business name Costco Wholesale Corporation
DBA Doing business as Costco Pharmacy # 1091
Authorized official Mastromonica, Michael
Entity Organization
Organization subpart 1 No
Enumeration date May 2nd, 2011
Last updated Aug 18th, 2014 - about 10 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 1922399419 NPPES
Other 5640900 NCPDP PROVIDER IDENTIFICATION NUMBER

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