NPIMap

Organization Active NPI

Meijer Stores Limited Partnership

  • Community/Retail Pharmacy
  • Cincinnati, OH
National Provider Identifier
1174723167
Registry record updated Mar 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
021698550 Issued in OH
Legal business name
MEIJER STORES LIMITED PARTNERSHIP
Practice address
3711 Stonecreek Blvd
Cincinnati, OH 45251-1457
Phone
(513) 245-7510
Fax
(513) 245-7565
NPI assigned
Jul 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2014

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

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 021698550 OH
Community/Retail Pharmacy 3336C0003X 021698550 OH Primary

Addresses

Primary practice location

3711 Stonecreek Blvd
Cincinnati, OH 45251-1457

Mailing address

2929 Walker Ave NW
Grand Rapids, MI 49544-9424
Phone (616) 791-3169

Other identifiers 1

IdentifierTypeStateIssuer
2767386MedicaidOH

Other names 1

  • Mejjer Pharmacy #240 Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120626000668 OH DME Supplier - PharmacyDME Supplier - Department StoreDME Supplier - Grocery Store 2062688971 1 other NPI on this enrollment
Practice locations: Cincinnati, OH
O20130605000647 OH Part B Supplier - Mass Immunization (Roster Biller Only) 2062688971 This NPI is an additional NPI on the enrollment

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 24

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

View all 24

Member of 1

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

Locations

3711 Stone Creek Blvd
Cincinnati, OH 45251
Phone (513) 245-1700

NPI Registry JSON

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395705600000",
    "number": "1174723167",
    "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": "3711 STONECREEK BLVD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452511457",
            "telephone_number": "513-245-7510",
            "fax_number": "513-245-7565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER STORES LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-19",
        "last_updated": "2014-03-25",
        "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": "OH",
            "license": "021698550",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "021698550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2767386",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mejjer Pharmacy #240",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.