Healthcare Provider Details

I. General information

NPI: 1164882890
Provider Name (Legal Business Name): MEIJER STORES LTD PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E ALEXIS RD
TOLEDO OH
43612-3952
US

IV. Provider business mailing address

1500 E ALEXIS RD
TOLEDO OH
43612-3952
US

V. Phone/Fax

Practice location:
  • Phone: 419-727-2010
  • Fax: 419-727-2065
Mailing address:
  • Phone: 419-727-2010
  • Fax: 419-727-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03335063
License Number StateOH

VIII. Authorized Official

Name: DR. ANDREW JOSEPH ROBERTSON
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 419-727-2010