Organization
MEIJER STORES LIMITED PARTNERSHIP
Active
Other names
Meijer Pharmacy #298
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
2015 SHAWANO AVE, GREEN BAY, WI 54303-2606
(920) 496-8110
(920) 496-8165
Mailing address
2929 WALKER AVE NW, ATTN: MANAGED CARE GOVERNMENT PROGRAMS, GRAND RAPIDS, MI 49544-6402
(616) 791-3169
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100065871
—
WI
05
—
1215472089
—
MI
Enumeration date
01/03/2017
Last updated
06/02/2017
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