Organization
MEIJER STORES LIMITED PARTNERSHIP
Active
Other names
Meijer Pharmacy #274
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
1600 N. PORT WASHINGTON RD., GRAFTON, WI 53024-9771
(262) 204-2810
(262) 204-2765
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
9312
WI
3336C0003X
Community/Retail Pharmacy
Primary
9312
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100045172
—
WI
Enumeration date
04/06/2015
Last updated
07/09/2015
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