# MEIJER STORES LIMITED PARTNERSHIP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Meijer Pharmacy \#277
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093195596
- **Authorized official:** JASON BEAUCH R.PH (DIRECTOR OF PHARMACY MANAGED CARE)
- **Authorized official phone:** (616) 791-3169

## Contact information

- **Practice address:** 11111 W BURLEIGH ST, WAUWATOSA, WI 53222-3211
- **Practice address phone:** (414) 290-0910
- **Practice address fax:** (414) 256-4765
- **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 | — | WI | — |
| 3336C0003X | Community/Retail Pharmacy | — | WI | Yes |

## Other

- **Enumeration date:** 06/01/2015
- **Last updated:** 09/01/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100046221 | — | WI |