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NPI Code Detail

MEDICARE: MEIJER INC

MEDICARE: MEIJER INC
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
1332B00000XDurable Medical Equipment & Medical Supplies5301005163MI
23336C0003XCommunity/Retail Pharmacy5301005163MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669512174
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEIJER INC
Provider Business Mailing Address
First Line : 2929 WALKER AVE NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49544-9424
Country : US
Telephone Number : 616-791-3169
Fax Number : 616-735-8532
Provider Business Practice Location Address
First Line : 15055 HALL RD
Second Line :
City : SHELBY TOWNSHIP
State : MI
Zip : 48315-6206
Country : US
Telephone Number : 586-566-4110
Fax Number : 586-566-4165
Authorized Official
Title or Position : DIRECTOR OF PHARMACY MANAGED CARE
Name : JASON BEAUCH
Credential : RPH
Telephone Number : 616-791-3169
Provider Enumeration Date : 02/07/2007
Last Update Date : 03/17/2014

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