Organization
MEIJER STORES LIMITED PARTNERSHIP
Active
Other names
Meijer Pharmacy #120
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BEAUCH RPH (DIRECTOR OF PHARMACY MANAGED CARE)
(616) 791-3169
Entity
Organization
Contact information
Practice address
3600 PORTAGE RD, SOUTH BEND, IN 46628
(574) 273-3410
(574) 273-3465
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
60004375
IN
3336C0003X
Community/Retail Pharmacy
Primary
60004375
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033489844
—
MI
05
—
201079210A
—
IN
Enumeration date
01/10/2012
Last updated
03/19/2014
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