Organization
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Active
Organization
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Active
Other names
Meijer Pharmacy #151
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON BEAUCH R.PH (DIRECTOR, PHARMACY MANAGED CARE)
(616) 791-3169
Entity
Organization
Contact information
Practice address
4990 HOUSTON RD, FLORENCE, KY 41042-4851
(859) 746-6310
(859) 746-6365
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
P06540
KY
3336C0003X
Community/Retail Pharmacy
Primary
P06540
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0094703
—
OH
05
—
201191660A
—
IN
05
—
7100211640
—
KY
Enumeration date
09/13/2007
Last updated
03/21/2014
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