Active NPI
Meijer, Inc.
Doing business as Meijer Pharmacy #302
- Community/Retail Pharmacy
- Marquette, MI
National Provider Identifier
1366943979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- MEIJER, INC.
- Doing business as
- Meijer Pharmacy #302
- Practice address
- 3630 US 41 W
Marquette, MI 49855 - Phone
- (906) 662-6310
- Fax
- (906) 662-6365
- NPI assigned
- Feb 28, 2018
- Last updated
- Jun 25, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jason Beauch
- Title
- Vice President of Pharmacy
- Phone
- (616) 791-5032
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | NU | Primary |
Addresses
Primary practice location
3630 US 41 W
Marquette, MI 49855
Mailing address
2929 Walker Ave NW
Grand Rapids, MI 49544-6402
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366943979 | Medicaid | MI |
Other names 1
- Meijer Pharmacy #302
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 2
| 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 |
| O20180720002658 | MI | DME Supplier - Pharmacy | 8325015639 | Practice locations: Marquette, MI |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2146510 | Meijer Pharmacy #302 | Certificate of waiver | Mar 29, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Meijer Pharmacy #302 | 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 | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Meijer Pharmacy 337
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.
Practitioners & affiliated clinicians
Practitioners 4
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.
-
- Pharmacist
- Marquette, MI
- NPI 1740163682
-
- Pharmacist
- Marquette, MI
- NPI 1902208218
-
- Pharmacist
- Marquette, MI
- NPI 1407980469
-
- Pharmacist
- Marquette, MI
- NPI 1639656135
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519776000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1529884800000",
"number": "1366943979",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3630 US 41 W",
"city": "MARQUETTE",
"state": "MI",
"postal_code": "49855",
"telephone_number": "906-662-6310",
"fax_number": "906-662-6365"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEIJER, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2018-02-28",
"last_updated": "2018-06-25",
"status": "A",
"authorized_official_last_name": "BEAUCH",
"authorized_official_first_name": "JASON",
"authorized_official_title_or_position": "VICE PRESIDENT OF PHARMACY",
"authorized_official_telephone_number": "616-791-5032"
},
"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": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1366943979",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Meijer Pharmacy #302",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Marquette, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; 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.