Organization
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Active
Other names
Meijer Pharmacy #168
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
5400 ALEXANDRIA PIKE, COLD SPRING, KY 41076-2169
(859) 448-4210
(859) 448-4265
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
P06546
KY
3336C0003X
Community/Retail Pharmacy
Primary
P06546
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0094702
—
OH
05
—
7100211690
—
KY
Enumeration date
09/18/2007
Last updated
03/24/2014
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