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Organization
MEIJER STORES LIMITED PARTNERSHIP
Active
Organization
MEIJER STORES LIMITED PARTNERSHIP
Active
Other names
Meijer Pharmacy #284
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BEAUCH R.PH (DIRECTOR OF PHARMACY MANAGED CARE)
(616) 791-3169
Entity
Organization
Contact information
Practice address
7701 GREEN BAY RD, KENOSHA, WI 53142-4043
(262) 612-1610
(262) 612-1665
Mailing address
2929 WALKER AVE NW, GRAND RAPIDS, MI 49544-6402
(616) 791-3169
(616) 735-8532
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
9313
WI
3336C0003X
Community/Retail Pharmacy
Primary
9313
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100045194
—
WI
Enumeration date
03/30/2015
Last updated
07/09/2015
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