Meijer Inc
Organization Active NPI Community/Retail Pharmacy · North Muskegon, MI
NPI 1215077656 · NPPES record last updated Mar 17, 2014
Key facts
- NPI
- 1215077656
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 5301005432 (MI)
- Legal business name
- MEIJER INC
- Practice address
- 1800 Holton Rd
North Muskegon, MI 49445-1532 - Phone
- (231) 744-7610
- Fax
- (231) 744-7665
- NPI assigned
- Feb 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Jason Beauch, RPH
- Title
- Director of Pharmacy Managed Care
- Phone
- (616) 791-3169
Corporate family (same tax ID) 24
Practitioners 2
-
Brenda Adamczak, RPH
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Meijer Pharmacy #071 |
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|Surgical Dressings | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071022000424 | MI | Part B Supplier - Mass Immunization (Roster Biller Only) | 8325015639 | This NPI is an additional NPI on the enrollment |
| O20100930026264 | MI | DME Supplier - Pharmacy |
8325015639 | Practice locations: North Muskegon, MI |
National Provider Directory
- Tax ID family
- Meijer
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 5301005432 | MI | |
| Community/Retail Pharmacy | 3336C0003X | 5301005432 | MI | Yes |
Addresses
Primary practice location
1800 Holton Rd
North Muskegon, MI 49445-1532
Mailing address
2929 Walker Ave NW
Grand Rapids, MI 49544-9424
Phone (616) 791-3169
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2347474 | Medicaid | MI |
Other names
- Meijer Pharmacy #071
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All providers in North Muskegon, MI · Community/Retail Pharmacy in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 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.