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General NPI Number Information
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NPI Number | 1902378813
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Entity Type | Organization
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Legal Business Name | MEIJER GREAT LAKES LIMITED PARTNERSHIP
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Dates
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Enumeration Date | 12/18/2018
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 1676 WESTPARK DR
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City | BOWLING GREEN
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State | KY
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Zip | 42104-4712
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Country | US
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Telephone | 270-495-6710
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Fax | 270-495-6765
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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 | 616-581-3994
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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 | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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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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