Organization
MEIJER STORES LIMITED PARTNERSHIP
Active
Other names
Meijer Pharmacy #190
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
2990 N WAYNE ST, ANGOLA, IN 46703-9121
(260) 668-1110
(260) 668-1165
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
60005506
IN
3336C0003X
Community/Retail Pharmacy
Primary
600055506
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0094701
—
OH
05
—
201079430A
—
IN
Enumeration date
01/18/2012
Last updated
03/24/2014
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