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General NPI Number Information
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NPI Number | 1740725514
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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 | 01/03/2017
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 505 N 26TH ST
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City | ESCANABA
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State | MI
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Zip | 49829-1422
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Country | US
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Telephone | 906-233-1110
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Fax | 906-233-1165
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Provider Business Mailing Address
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Address Line | 2929 WALKER AVE NW ATTN: PHARMACY MANAGED CARE GOVERNMENT PROGRAMS
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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 | 616-791-3169
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Fax |
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Authorized Official
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Title or Position | VP OF PHARMACY MERCHANDISING
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Name | JASON BEAUCH
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Credential | R.PH
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Telephone | 616-791-3169
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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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