Organization
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Active
Organization
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Active
Other names
Meijer Pharmacy #164
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON BEAUCH RPH (DIRECTOR OF PHARMACY MANAGED CARE)
(616) 791-3169
Entity
Organization
Contact information
Practice address
4100 TOWNE CENTER DR, LOUISVILLE, KY 40241-4153
(502) 326-5210
(502) 326-5265
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
P06544
KY
3336C0003X
Community/Retail Pharmacy
Primary
P06544
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201191670A
—
IN
05
—
7100211730
—
KY
Enumeration date
09/18/2007
Last updated
03/24/2014
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