NPIMap

Meijer Stores Limited Partnership

Organization Active NPI Community/Retail Pharmacy · Merrillville, IN

NPI 1083985956 · NPPES record last updated Mar 24, 2014

Key facts

NPI
1083985956
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
60005267 (IN)
Legal business name
MEIJER STORES LIMITED PARTNERSHIP
Practice address
611 E US Highway 30
Merrillville, IN 46410
Phone
(219) 650-3710
Fax
(219) 650-3765
NPI assigned
Jan 24, 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

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 42

Corporate family (same tax ID) 16

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

Practitioners 1

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D1008261Meijer Pharmacy #165
611 US 30, Merrillville, IN 46410		Certificate of waiverJan 14, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Meijer Pharmacy # 165
611 W US Highway 30, Merrillville, IN 46410-5307 · (219) 650-3710		 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers Accepts assignment
Participating since Nov 23, 2011

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IN

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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…
O20120625000077 IN DME Supplier - Pharmacy
DME Supplier - Department Store
DME Supplier - Grocery Store		 2062688971 Practice locations: Merrillville, IN

National Provider Directory

Tax ID family
Meijer Stores LP (105 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 60005267 IN
Community/Retail Pharmacy 3336C0003X 60005267 IN Yes

Addresses

Primary practice location

611 E US Highway 30
Merrillville, IN 46410

Mailing address

2929 Walker Ave NW
Grand Rapids, MI 49544-6402
Phone (616) 791-3169

Other identifiers

IdentifierTypeStateIssuer
201079350AMedicaidIN

Other names

  • Meijer Pharmacy #165 Doing business as

Other providers in Merrillville, IN

All providers in Merrillville, IN · Community/Retail Pharmacy in Indiana

Sources for this page

Verify at the official NPI Registry.