NPIMap

Organization Active NPI

Meijer Stores Limited Partnership

Doing business as Meijer Pharmacy #682

  • Community/Retail Pharmacy
  • Noblesville, IN
National Provider Identifier
1124885041
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MEIJER STORES LIMITED PARTNERSHIP
Doing business as
Meijer Pharmacy #682
Practice address
5956 Promenade Shops Blvd
Noblesville, IN 46062-5601
Phone
(317) 774-7850
NPI assigned
Mar 6, 2024
Last updated
Mar 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2024

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

Authorized official

Name
Joseph Back
Title
Director Managed Care
Phone
(616) 791-3485

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

5956 Promenade Shops Blvd
Noblesville, IN 46062-5601

Mailing address

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

Other names 1

  • Meijer Pharmacy #682 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

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…

Other NPIs on the same Medicare enrollment 42

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

View all 42

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
15D2305533Meijer Pharmacy #6825956 Promenade Shops Blvd, Noblesville, IN 46062Certificate of waiverJun 2, 2028

National Provider Directory

National Provider Directory
Tax ID family
Meijer Stores Limited Partnership105 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 19

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

View all 19

Locations (25 of 77)

6610 S Scatterfield Rd
#136
Anderson, IN 46013
Phone (765) 683-5210

2990 N Wayne St
#190
Angola, IN 46703
Phone (260) 668-1110

10841 E US Highway 36
Avon, IN 46123
Phone (317) 273-6000

10841 E US Highway 36
#133
Avon, IN 46123
Phone (317) 273-6010

10509 Heartland Blvd
#204
Camby, IN 46113
Phone (317) 821-6810

1424 W Carmel Dr
#130
Carmel, IN 46032
Phone (317) 573-8310

2500 Cassopolis St
#328
Elkhart, IN 46514
Phone (574) 359-7850

2622 Menards Dr
#287
Evansville, IN 47715
Phone (812) 647-2210

10301 E State Road 37
#138
Fort Wayne, IN 46835
Phone (260) 492-1310

4242 E DuPont Rd
Fort Wayne, IN 46825
Phone (260) 279-2520

5909 Illinois Rd
#125
Fort Wayne, IN 46804
Phone (260) 434-3910

6309 Lima Rd
#124
Fort Wayne, IN 46818
Phone (260) 497-1010

2390 N Morton St
#295
Franklin, IN 46131
Phone (317) 346-9610

4522 Elkhart Rd
#127
Goshen, IN 46526
Phone (574) 875-3010

150 Marlin Dr
#132
Greenwood, IN 46142
Phone (317) 885-3010

10138 Indianapolis Blvd
#170
Highland, IN 46322
Phone (219) 934-2110

11351 E Washington St
Indianapolis, IN 46229
Phone (317) 891-1840

11351 E Washington St
#131
Indianapolis, IN 46229
Phone (317) 894-6710

5325 E Southport Rd
#134
Indianapolis, IN 46237
Phone (317) 859-2210

5349 W Pike Plaza Rd
#129
Indianapolis, IN 46254
Phone (317) 387-2410

5550 N Keystone Ave
#290
Indianapolis, IN 46220
Phone (317) 610-2210

2750 Allison Ln
#167
Jeffersonville, IN 47130
Phone (812) 218-6610

2301 E Markland Ave
#141
Kokomo, IN 46901
Phone (765) 454-7810

4901 State Road 26 E
#137
Lafayette, IN 47905
Phone (765) 449-9210

3820 S Western Ave
#153
Marion, IN 46953
Phone (765) 677-6810

Practitioners & affiliated clinicians

Practitioners 52

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1709683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709683200000",
    "number": "1124885041",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5956 PROMENADE SHOPS BLVD",
            "city": "NOBLESVILLE",
            "state": "IN",
            "postal_code": "460625601",
            "telephone_number": "317-774-7850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER STORES LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-06",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A",
        "authorized_official_last_name": "BACK",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "DIRECTOR MANAGED CARE",
        "authorized_official_telephone_number": "616-791-3485"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #682",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Noblesville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; 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.