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General NPI Number Information
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NPI Number | 1598805053
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Entity Type | Organization
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Legal Business Name | MEIJER STORES LIMITED PARTNERSHIP
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 1155 N 21ST ST
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City | NEWARK
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State | OH
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Zip | 43055-3016
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Country | US
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Telephone | 740-366-2311
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Fax | 740-366-8465
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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 | 49544-9424
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Country | US
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Telephone | 616-791-3346
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Fax | 616-735-8532
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Authorized Official
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Title or Position | DIRECTOR, PHARMACY ADMINISTRATION
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Name | MR. KEVIN R. HURN
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Credential | RPH
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Telephone | 616-791-5185
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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 | 0217660
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License Number State | OH
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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 | 02176600
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License Number State | OH
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