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General NPI Number Information
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NPI Number | 1548650146
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Entity Type | Organization
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Legal Business Name | MEIJER GREAT LAKES LTD PT
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 12821 CROSS OVER DR
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City | DEWITT
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State | MI
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Zip | 48820-7993
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Country | US
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Telephone | 517-669-4610
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Fax |
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Provider Business Mailing Address
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Address Line | 12821 CROSS OVER DR
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City | DEWITT
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State | MI
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Zip | 48820-7993
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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 | PHARMACY SPECIALIST
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Name | ELIZABETH LINDER
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Credential |
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Telephone | 517-391-5807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5302040403
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License Number State | MI
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