# MEIJER GREAT LAKES LIMITED PARTNERSHIP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Meijer Pharmacy \#176
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013287853
- **Authorized official:** JASON BEAUCH RPH (DIRECTOR OF PHARMACY MANAGED CARE)
- **Authorized official phone:** (616) 791-3169

## Contact information

- **Practice address:** 4200 CONESTOGA DR, SPRINGFIELD, IL 62711-7962
- **Practice address phone:** (217) 547-2410
- **Practice address fax:** (217) 547-2465
- **Mailing address:** 2929 WALKER AVE NW, GRAND RAPIDS, MI 49544-6402
- **Mailing address phone:** (616) 791-3169
- **Mailing address fax:** (616) 735-8532

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 054014283 | IL | — |
| 3336C0003X | Community/Retail Pharmacy | 054014283 | IL | Yes |

## Other

- **Enumeration date:** 01/11/2012
- **Last updated:** 03/24/2014