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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1861083800
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	:	616-791-3485
Fax Number	:	616-735-8532

Provider Business Practice Location Address
First Line	:	7701 BROADVIEW RD
Second Line	:
City	:	SEVEN HILLS
State	:	OH
Zip	:	44131-5724
Country	:	US
Telephone Number	:	216-238-9720
Fax Number	:	216-238-9734

Authorized Official
Title or Position	:	DIRECTOR OF MANAGED CARE
Name	:	RAYMOND F BURZYNSKI
Credential	:
Telephone Number	:	616-249-6583

Provider Enumeration Date	:	02/02/2021
Last Update Date	:	02/17/2021

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