NPIMap

Organization Active NPI

Meijer Inc

  • Community/Retail Pharmacy
  • Southgate, MI
National Provider Identifier
1487716296
Registry record updated Mar 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301006055 Issued in MI
Legal business name
MEIJER INC
Practice address
16300 Fort St
Southgate, MI 48195-1421
Phone
(734) 284-4250
Fax
(734) 284-4763
NPI assigned
Dec 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2014

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 5301006055 MI
Community/Retail Pharmacy 3336C0003X 5301006055 MI Primary

Addresses

Primary practice location

16300 Fort St
Southgate, MI 48195-1421

Mailing address

2929 Walker Ave NW
Grand Rapids, MI 49544-9424
Phone (616) 791-3169

Other identifiers 1

IdentifierTypeStateIssuer
2353047MedicaidMI

Other names 1

  • Meijer Pharmacy #123 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071022000424 MI Part B Supplier - Mass Immunization (Roster Biller Only) 8325015639 This NPI is an additional NPI on the enrollment
O20100930064135 MI DME Supplier - PharmacyDME Supplier - Department StoreDME Supplier - Grocery Store 8325015639 Practice locations: Southgate, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D1004098Meijer Pharmacy #12316300 Fort Street, Southgate, MI 48195Certificate of waiverSep 18, 2026

National Provider Directory

National Provider Directory
Tax ID family
Meijer127 organizations share this tax ID, including this one

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.

View all 24

Locations

16300 Fort St
Southgate, MI 48195
Phone (734) 284-4250

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395187200000",
    "number": "1487716296",
    "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": "495449424",
            "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": "16300 FORT ST",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951421",
            "telephone_number": "734-284-4250",
            "fax_number": "734-284-4763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2014-03-19",
        "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": "MI",
            "license": "5301006055",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301006055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2353047",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #123",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southgate, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; 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.

Verify at the official NPI Registry.