Organization
MEIJER STORES LIMITED PARTNERSHIP
Active
Other names
Meijer Pharmacy #275
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BEAUCH (VP OF PHARMACY MERCHANDISING)
(616) 791-3169
Entity
Organization
Contact information
Practice address
N51W24953 LISBON RD, PEWAUKEE, WI 53072-1403
(262) 932-2510
(262) 932-2465
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
9401-42
WI
3336C0003X
Community/Retail Pharmacy
Primary
9401-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100057670
—
WI
Enumeration date
03/18/2016
Last updated
07/15/2016
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