# MEIJER STORES LIMITED PARTNERSHIP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Meijer Pharmacy \#304
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104458140
- **Authorized official:** RAYMOND BURZYNSKI (DIRECTOR OF PHARMACY MANAGED CARE)
- **Authorized official phone:** (616) 249-6583

## Contact information

- **Practice address:** 1818 S. RAPIDS RD, MANITOWOC, WI 54220-9302
- **Practice address phone:** (920) 663-3846
- **Practice address fax:** (920) 663-3865
- **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:** 02/07/2020
- **Last updated:** 07/09/2020