Meijer Stores Limited Partnership
Organization Active NPI Community/Retail Pharmacy · Portage, IN
NPI 1457796542 · NPPES record last updated Mar 25, 2014
Key facts
- NPI
- 1457796542
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 60006337 (IN)
- Legal business name
- MEIJER STORES LIMITED PARTNERSHIP
- Practice address
- 6050 US Highway 6
Portage, IN 46368-5047 - Phone
- (219) 763-0310
- Fax
- (219) 763-0365
- NPI assigned
- May 3, 2013
- Organization subpart
- No
Authorized official
- Name
- Jason Beauch, R.PH
- Title
- Director of Pharmacy Managed Care
- Phone
- (616) 791-3169
Other NPIs on the same Medicare enrollment 42
Corporate family (same tax ID) 24
Member of 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2059746 | Meijer Pharmacy #266 | Certificate of waiver | May 29, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Meijer Stores Limited Partnership |
Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111227000308 | IN | Part B Supplier - Mass Immunization (Roster Biller Only) | 2062688971 |
42 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lafayette, IN; New Albany, IN; Muncie, IN; Mishawaka, IN; Michigan City, IN; Merrillville, IN; McCordsville, IN; Marion, IN… |
| O20130926000029 | IN | DME Supplier - Pharmacy |
2062688971 | Practice locations: Portage, IN |
National Provider Directory
- Tax ID family
- Meijer Stores LP
Locations
6050 US Highway 6
Portage, IN 46368
Phone (219) 762-6912
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 60006337 | IN | |
| Community/Retail Pharmacy | 3336C0003X | 60006337 | IN | Yes |
Addresses
Primary practice location
6050 US Highway 6
Portage, IN 46368-5047
Mailing address
2929 Walker Ave NW
Grand Rapids, MI 49544-6402
Phone (616) 791-3169
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201174300A | Medicaid | IN |
Other names
- Meijer Pharmacy #266
Other providers in Portage, IN
- Kaley McLendon
- Medical Associates of Nwi LLC
- Austre Berta Medina
- Suzanne N Meeks
- Shaun Sadruddin Mehdi
- Melody Home Care Services LLC
- Elizabeth E Menges
- Gretchen Mercer
- Mercy Diagnostics Inc
- Mercy Midwest LLC
All providers in Portage, IN · Community/Retail Pharmacy in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 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.