Organization
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Active
Other names
Meijer Pharmacy #160
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
4500 S HURSTBOURNE PKWY, LOUISVILLE, KY 40299-6376
(502) 493-4910
(502) 493-4965
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
P06541
KY
3336C0003X
Community/Retail Pharmacy
Primary
P06541
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100211740
—
KY
Enumeration date
09/17/2007
Last updated
03/24/2014
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