Meijer Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301002860 Issued in MI

Legal business name

MEIJER INC

Practice address

3825 Carpenter Rd
Ypsilanti, MI 48197-9606

Phone

(734) 677-7110

Fax

(734) 677-7165

NPI assigned

Feb 6, 2007

Organization subpart

No

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

Authorized official

Name

Jason Beauch, RPH

Title

Director of Pharmacy Managed Care

Phone

(616) 791-3169

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Meijer Pharmacy #027 Doing business as

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394496000000",
    "number": "1114066008",
    "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": "495449424",
            "telephone_number": "616-791-3169",
            "fax_number": "616-735-8532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3825 CARPENTER RD",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481979606",
            "telephone_number": "734-677-7110",
            "fax_number": "734-677-7165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2014-03-11",
        "status": "A",
        "authorized_official_last_name": "BEAUCH",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY MANAGED CARE",
        "authorized_official_telephone_number": "616-791-3169",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "5301002860",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301002860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2305387",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #027",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kyle Medley, DO
• Iyonna Amari Meeks
• Meera Shayndel Meerkov, M.D.
• Kilayna Meester, DNP/CRNA
• Wan Yi Mei
• Hannah Grace Meissner
• Margaret Balemba Mekai Vekima, M.D.
• Alex Melody, LMSW
• Mary Jane Melong, NP
• Melissa Elana Melvin, M.D.

• Community/Retail Pharmacy in Ypsilanti, MI
• Providers in Ypsilanti, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.