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General NPI Number Information
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NPI Number | 1376007518
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Entity Type | Organization
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Legal Business Name | MEIJER, INC.
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 4665 S GREEN AVE
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City | FREMONT
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State | MI
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Zip | 49412-9509
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Country | US
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Telephone | 231-538-2710
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Fax | 231-538-2765
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Provider Business Mailing Address
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Address Line | 2929 WALKER AVE NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49544-6402
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF MANAGED CARE
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Name | MINDY EDGAR
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Credential | PHARMD
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Telephone | 616-791-3961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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