Organization
MEIJER STORES LIMITED PARTNERSHIP
Active
Other names
Meijer Pharmacy #287
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BEAUCH R.PH (VP OF PHARMACY MERCHANDISING)
(616) 791-3169
Entity
Organization
Contact information
Practice address
2622 MENARDS DR, EVANSVILLE, IN 47715-8075
(812) 647-2210
(812) 647-2165
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
60006565A
IN
3336C0003X
Community/Retail Pharmacy
Primary
60006565A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201164000B
—
IN
05
—
7100400710
—
KY
Enumeration date
03/14/2016
Last updated
06/23/2016
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