NPIMap

Organization Active NPI

Meijer Stores Limited Partnership

  • Pharmacy
  • Canton, OH
National Provider Identifier
1013668870
Registry record updated Jan 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
MEIJER STORES LIMITED PARTNERSHIP
Practice address
4934 Fulton Dr NW
Canton, OH 44718-2392
Phone
(234) 804-0884
Fax
(234) 804-0875
NPI assigned
Jan 13, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ian Nagy, RPH
Title
Manager Government Managed Gcare
Phone
(616) 249-6272

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X Primary

Addresses

Primary practice location

4934 Fulton Dr NW
Canton, OH 44718-2392

Mailing address

2929 Walker Ave NW
Grand Rapids, MI 49544-6402
Phone (616) 791-3485

Other names 1

  • Meijer Pharmacy #325 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130605000647 OH Part B Supplier - Mass Immunization (Roster Biller Only) 2062688971 This NPI is an additional NPI on the enrollment
O20220614000659 OH DME Supplier - PharmacyDME Supplier - Department StoreDME Supplier - Grocery Store 2062688971 Practice locations: Canton, OH

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2256769Meijer Pharmacy #3254934 Fulton Dr NW, Canton, OH 44718Certificate of waiverMar 27, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Meijer Pharmacy #3254934 Fulton Dr NW, Canton, OH 44718-2392(234) 804-0884 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers Accepts assignmentParticipating since Nov 23, 2011

National Provider Directory

National Provider Directory
Tax ID family
Meijer Stores LP105 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642032000000",
    "number": "1013668870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 WALKER AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495446402",
            "telephone_number": "616-791-3485",
            "fax_number": "616-735-8532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4934 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182392",
            "telephone_number": "234-804-0884",
            "fax_number": "234-804-0875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER STORES LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-13",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-13",
        "status": "A",
        "authorized_official_last_name": "NAGY",
        "authorized_official_first_name": "IAN",
        "authorized_official_title_or_position": "MANAGER GOVERNMENT MANAGED GCARE",
        "authorized_official_telephone_number": "616-249-6272",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #325",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.