Organization
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Active
Other names
Meijer Pharmacy #269
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON BEAUCH R.PH (DIRECTOR OF PHARMACY MANAGED CARE)
(616) 791-3169
Entity
Organization
Contact information
Practice address
3649 N. VERMILION ST., DANVILLE, IL 61832-1312
(217) 655-7210
(217) 655-7265
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
054018334
IL
3336C0003X
Community/Retail Pharmacy
Primary
054018334
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201204100A
—
IL
Enumeration date
10/03/2013
Last updated
03/25/2014
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