Healthcare Provider Details

I. General information

NPI: 1174455141
Provider Name (Legal Business Name): MEIJER PHARMACY #683
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 WALKER AVE NW
GRAND RAPIDS MI
49544-6402
US

IV. Provider business mailing address

2929 WALKER AVE NW
GRAND RAPIDS MI
49544-9428
US

V. Phone/Fax

Practice location:
  • Phone: 616-791-3485
  • Fax:
Mailing address:
  • Phone: 616-791-3485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LUKE GUMPER
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 616-791-3485