MEDICARE: MEIJER STORES LIMITED PARTNERSHIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency
2	3336S0011X	Specialty Pharmacy	5301010933	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568818391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEIJER STORES LIMITED PARTNERSHIP

Provider Business Mailing Address
First Line	:	2929 WALKER AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49544-6402
Country	:	US
Telephone Number	:	616-791-5274
Fax Number	:

Provider Business Practice Location Address
First Line	:	8455 HAGGERTY RD
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-1607
Country	:	US
Telephone Number	:	734-391-2310
Fax Number	:	734-391-2365

Authorized Official
Title or Position	:	VP OF PHARMACY MERCHANDISING
Name	:	JACKIE MORSE
Credential	:
Telephone Number	:	616-791-3169

Provider Enumeration Date	:	05/11/2016
Last Update Date	:	08/12/2025

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Directions to “MEIJER STORES LIMITED PARTNERSHIP ” Practice Location

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