Organization
MEIJER INC
Active
Other names
Meijer Pharmacy #056
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
3333 E MICHIGAN AVE, JACKSON, MI 49202-3853
(517) 783-0210
(517) 783-0265
Mailing address
2929 WALKER AVE NW, GRAND RAPIDS, MI 49544-9424
(616) 791-3169
(616) 735-8532
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
5301004393
MI
3336C0003X
Community/Retail Pharmacy
Primary
5301004393
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2340393
—
MI
Enumeration date
02/07/2007
Last updated
03/17/2014
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