Organization
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Active
Organization
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Active
Other names
Meijer Pharmacy #272
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON BEAUCH R.PH (DIRECTOR OF PHARMACY MANAGED CARE)
(616) 791-3169
Entity
Organization
Contact information
Practice address
1676 WESTPARK DR., BOWLING GREEN, KY 42104-4712
(270) 495-6710
(270) 495-6765
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
P07629
KY
3336C0003X
Community/Retail Pharmacy
Primary
P07629
KY
3336S0011X
Specialty Pharmacy
P07629
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346650850
—
TN
05
—
7100305600
—
KY
Enumeration date
05/06/2014
Last updated
10/20/2017
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