# MEIJER STORES LIMITED PARTNERSHIP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Meijer Pharmacy \#102
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699830455
- **Authorized official:** JASON BEAUCH R.PH (DIRECTOR OF PHARMACY MANAGED CARE)
- **Authorized official phone:** (616) 791-3169

## Contact information

- **Practice address:** 4075 WILMINGTON PIKE, KETTERING, OH 45440-1603
- **Practice address phone:** (937) 297-8610
- **Practice address fax:** (937) 297-8665
- **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 | 02654650 | OH | — |
| 3336C0003X | Community/Retail Pharmacy | 02654650 | OH | Yes |

## Other

- **Enumeration date:** 12/22/2006
- **Last updated:** 03/17/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0834619 | — | OH |