NPIMap

Organization Active NPI

Meijer Great Lakes Limited Partnership

  • Community/Retail Pharmacy
  • Bowling Green, KY
National Provider Identifier
1346650850
Registry record updated Oct 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
P07629 Issued in KY
Legal business name
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Doing business as
Meijer Pharmacy #272
Practice address
1676 Westpark Dr.
Bowling Green, KY 42104-4712
Phone
(270) 495-6710
Fax
(270) 495-6765
NPI assigned
May 6, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2017

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

Authorized official

Name
Mr. Jason Beauch, R.PH
Title
Director of Pharmacy Managed Care
Phone
(616) 791-3169

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X P07629 KY
Community/Retail Pharmacy 3336C0003X P07629 KY Primary
Specialty Pharmacy 3336S0011X P07629 KY

Addresses

Primary practice location

1676 Westpark Dr.
Bowling Green, KY 42104-4712

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
7100305600MedicaidKY
1346650850MedicaidTN

Other names 1

  • Meijer Pharmacy #272 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130305000271 KY Part B Supplier - Mass Immunization (Roster Biller Only) 4385829480 10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Florence, KY; Richmond, KY; Owensboro, KY; Louisville, KY; Lexington, KY; Cold Spring, KY; Bowling Green, KY
O20140613001272 KY DME Supplier - Pharmacy 4385829480 Practice locations: Bowling Green, KY

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory

Member of 1

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

NPI Registry JSON

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

{
    "created_epoch": "1399334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508457600000",
    "number": "1346650850",
    "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": "616-791-3169",
            "fax_number": "616-735-8532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1676 WESTPARK DR.",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421044712",
            "telephone_number": "270-495-6710",
            "fax_number": "270-495-6765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER GREAT LAKES LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-06",
        "last_updated": "2017-10-20",
        "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_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "KY",
            "license": "P07629",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "P07629",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "KY",
            "license": "P07629",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100305600",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346650850",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #272",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2017; 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.