# MEIJER STORES LIMITED PARTNERSHIP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Meijer Pharmacy \#298
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215472089
- **Authorized official:** JASON BEAUCH R.PH (VP OF PHARMACY MERCHANDISING)
- **Authorized official phone:** (616) 791-3169

## Contact information

- **Practice address:** 2015 SHAWANO AVE, GREEN BAY, WI 54303-2606
- **Practice address phone:** (920) 496-8110
- **Practice address fax:** (920) 496-8165
- **Mailing address:** 2929 WALKER AVE NW, ATTN: MANAGED CARE GOVERNMENT PROGRAMS, GRAND RAPIDS, MI 49544-6402
- **Mailing address phone:** (616) 791-3169

## Taxonomy

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

## Other

- **Enumeration date:** 01/03/2017
- **Last updated:** 06/02/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100065871 | — | WI |
| 05 | — | 1215472089 | — | MI |