Organization
MEIJER STORES LIMITED PARTNERSHIP
Active
Other names
Meijer Pharmacy #152
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BEAUCH R.PH (DIRECTOR OF PHARMACY MANAGED CARE)
(616) 791-3169
Entity
Organization
Contact information
Practice address
6650 WHITESTOWN PKWY, ZIONSVILLE, IN 46077-7622
(317) 732-9210
(371) 732-9265
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
60006372
IN
3336C0003X
Community/Retail Pharmacy
Primary
60006372
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201219550A
—
IN
Enumeration date
04/07/2014
Last updated
05/22/2014
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