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NPI Code Detail

MEDICARE: MEIJER STORES LIMITED PARTNERSHIP

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
1332B00000XDurable Medical Equipment & Medical Supplies60004406IN
23336C0003XCommunity/Retail Pharmacy60004406IN

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 : 1841560646
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 : 616-791-3169
Fax Number :
Provider Business Practice Location Address
First Line : 5909 ILLINOIS RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-1159
Country : US
Telephone Number : 260-434-3910
Fax Number : 260-434-3965
Authorized Official
Title or Position : DIRECTOR OF PHARMACY MANAGED CARE
Name : JASON BEAUCH
Credential : RPH
Telephone Number : 616-791-3169
Provider Enumeration Date : 01/10/2012
Last Update Date : 03/19/2014

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Directions to “MEIJER STORES LIMITED PARTNERSHIP ” Practice Location

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