# MEIJER STORES LIMITED PARTNERSHIP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Meijer Pharmacy \#115
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114014362
- **Authorized official:** JASON BEAUCH RPH (DIRECTOR OF PHARMACY MANAGED CARE)
- **Authorized official phone:** (616) 791-3169

## Contact information

- **Practice address:** 1391 CONANT ST, MAUMEE, OH 43537-1609
- **Practice address phone:** (419) 891-8710
- **Practice address fax:** (419) 891-8765
- **Mailing address:** 2929 WALKER AVE NW, GRAND RAPIDS, MI 49544-9424
- **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 | 02723850 | OH | — |
| 3336C0003X | Community/Retail Pharmacy | 02723850 | OH | Yes |

## Other

- **Enumeration date:** 10/09/2006
- **Last updated:** 03/19/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0913702 | — | OH |
| 05 | — | 1114014362 | — | MI |