# MEIJER GREAT LAKES LIMITED PARTNERSHIP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Meijer Pharmacy \# 301
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003315680
- **Authorized official:** IAN NAGY (MANAGER, THIRD PARTY GOVT. PROGRAMS)
- **Authorized official phone:** (616) 249-6272

## Contact information

- **Practice address:** 990 N KINZIE AVE, BRADLEY, IL 60915
- **Practice address phone:** (779) 301-8210
- **Practice address fax:** (779) 301-8265
- **Mailing address:** 2929 WALKER AVE NW, GRAND RAPIDS, MI 49544-6402

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 02/08/2018
- **Last updated:** 09/07/2021