Organization
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Active
Other names
Meijer Pharmacy #169
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
225 N WEBER RD, BOLINGBROOK, IL 60490-1505
(630) 679-6510
(630) 679-6565
Mailing address
2929 WALKER AVE NW, GRAND RAPIDS, MI 49544
(616) 791-3169
(616) 735-8532
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
054014083
IL
3336C0003X
Community/Retail Pharmacy
Primary
054014083
IL
Other
Enumeration date
01/11/2012
Last updated
02/25/2021
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