NPIMap

Organization Active NPI

Meijer Stores Limited Partnership

Doing business as Meijer Pharmacy #307

  • Community/Retail Pharmacy
  • Stow, OH
National Provider Identifier
1558825786
Registry record updated May 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MEIJER STORES LIMITED PARTNERSHIP
Doing business as
Meijer Pharmacy #307
Practice address
4303 Kent Rd
Stow, OH 44224-4330
Phone
(234) 900-5710
Fax
(234) 900-5765
NPI assigned
Jan 22, 2019
Last updated
May 3, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2019

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)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

4303 Kent Rd
Stow, OH 44224-4330

Mailing address

2929 Walker Ave NW
Grand Rapids, MI 49544-6402

Other identifiers 1

IdentifierTypeStateIssuer
0344337MedicaidOH

Other names 1

  • Meijer Pharmacy #307 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130605000647 OH Part B Supplier - Mass Immunization (Roster Biller Only) 2062688971 This NPI is an additional NPI on the enrollment
O20190604001059 OH DME Supplier - PharmacyDME Supplier - Department StoreDME Supplier - Grocery Store 2062688971 Practice locations: Stow, OH

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
36D2160752Meijer Pharmacy #3074303 Kent Rd, Stow, OH 44224Certificate of waiverJan 16, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Meijer Pharmacy #3074303 Kent Rd, Stow, OH 44224-4330(234) 900-5710 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers Accepts assignmentParticipating since Nov 23, 2011

National Provider Directory

National Provider Directory
Tax ID family
Meijer Stores Limited Partnership105 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

Practitioners & affiliated clinicians

Practitioners 3

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.

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": "1556841600000",
    "number": "1558825786",
    "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": "4303 KENT RD",
            "city": "STOW",
            "state": "OH",
            "postal_code": "442244330",
            "telephone_number": "234-900-5710",
            "fax_number": "234-900-5765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER STORES LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-22",
        "last_updated": "2019-05-03",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0344337",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #307",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Meijer Pharmacy #307",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stow, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 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.

Verify at the official NPI Registry.