Active NPI
Meijer, Inc.
Doing business as Meijer Pharmacy #310
- Community/Retail Pharmacy
- Fremont, MI
National Provider Identifier
1376007518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- MEIJER, INC.
- Doing business as
- Meijer Pharmacy #310
- Practice address
- 4665 S Green Ave
Fremont, MI 49412-9509 - Phone
- (231) 538-2710
- Fax
- (231) 538-2765
- NPI assigned
- Jan 22, 2019
- Last updated
- Jan 22, 2019
- 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
- Mindy Edgar, PHARMD
- Title
- Director of Managed Care
- Phone
- (616) 791-3961
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
4665 S Green Ave
Fremont, MI 49412-9509
Mailing address
2929 Walker Ave NW
Grand Rapids, MI 49544-6402
Other names 1
- Meijer Pharmacy #310
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 |
| O20190614001001 | MI | DME Supplier - Pharmacy | 8325015639 | Practice locations: Fremont, 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 |
|---|---|---|---|
| 23D2160545 | Meijer Pharmacy #310 | Certificate of waiver | Jan 13, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Meijer Pharmacy #310 | Epoetin|Immunosuppressive 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.
Locations
4665 S Green Ave
Fremont, MI 49412
Phone (231) 538-2710
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548115200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1548115200000",
"number": "1376007518",
"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": "4665 S GREEN AVE",
"city": "FREMONT",
"state": "MI",
"postal_code": "494129509",
"telephone_number": "231-538-2710",
"fax_number": "231-538-2765"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEIJER, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2019-01-22",
"last_updated": "2019-01-22",
"status": "A",
"authorized_official_last_name": "EDGAR",
"authorized_official_first_name": "MINDY",
"authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE",
"authorized_official_telephone_number": "616-791-3961",
"authorized_official_credential": "PHARMD"
},
"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 #310",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fremont, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; 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.