Healthcare Provider Details

I. General information

NPI: 1659872240
Provider Name (Legal Business Name): MEIJER STORES LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 N. RICHMOND STREET
GRAND CHUTE WI
54913
US

IV. Provider business mailing address

2929 WALKER AVE NW
GRAND RAPIDS MI
49544-6402
US

V. Phone/Fax

Practice location:
  • Phone: 920-350-6210
  • Fax: 920-350-6265
Mailing address:
  • Phone: 616-791-5032
  • Fax: 616-735-8532

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: JASON BEAUCH
Title or Position: VICE PRESIDIENT OF PHARMACY
Credential:
Phone: 616-735-8014