Meijer Stores Limited Partnership
Organization Active NPI Community/Retail Pharmacy · Muncie, IN
NPI 1083984884 · NPPES record last updated Mar 21, 2014
Key facts
- NPI
- 1083984884
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 60004792 (IN)
- Legal business name
- MEIJER STORES LIMITED PARTNERSHIP
- Practice address
- 6260 W McGalliard Rd
Muncie, IN 47304-9413 - Phone
- (765) 281-7810
- Fax
- (765) 281-7865
- NPI assigned
- Jan 10, 2012
- Organization subpart
- No
Authorized official
- Name
- Jason Beauch, RPH
- Title
- Director of Pharmacy Managed Care
- Phone
- (616) 791-3169
Other NPIs on the same Medicare enrollment 42
Corporate family (same tax ID) 15
Member of 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D0998993 | Meijer Pharmacy 139 | Certificate of waiver | Apr 30, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Meijer Pharmacy # 139 |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111227000308 | IN | Part B Supplier - Mass Immunization (Roster Biller Only) | 2062688971 |
42 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lafayette, IN; New Albany, IN; Muncie, IN; Mishawaka, IN; Michigan City, IN; Merrillville, IN; McCordsville, IN; Marion, IN… |
| O20120621000019 | IN | DME Supplier - Pharmacy |
2062688971 | Practice locations: Muncie, IN |
National Provider Directory
- Tax ID family
- Meijer Stores LP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 60004792 | IN | |
| Community/Retail Pharmacy | 3336C0003X | 60004792 | IN | Yes |
Addresses
Primary practice location
6260 W McGalliard Rd
Muncie, IN 47304-9413
Mailing address
2929 Walker Ave NW
Grand Rapids, MI 49544-6402
Phone (616) 791-3169
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201079050A | Medicaid | IN |
Other names
- Meijer Pharmacy #139
Other providers in Muncie, IN
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- Medical Group of Indiana LLC D/B/a Rheumatology of Central Indiana
- Jason P Medler
- Rajeev Mehta
- Cale Jeffrey Melham
- Lynnea Melham
- Thomas J Melham
- Melissa Osner Counseling, LLC
- Paul F Mellen
All providers in Muncie, IN · Community/Retail Pharmacy in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.