NPIMap

Organization Active NPI

Meijer Stores Limited Partnership

Doing business as Meijer Pharmacy #124

  • Community/Retail Pharmacy
  • Fort Wayne, IN
National Provider Identifier
1578834974
Registry record updated May 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
60004404 Issued in IN
Legal business name
MEIJER STORES LIMITED PARTNERSHIP
Doing business as
Meijer Pharmacy #124
Practice address
6309 Lima Rd
Fort Wayne, IN 46818-1425
Phone
(260) 497-1010
Fax
(260) 497-1065
NPI assigned
Jan 18, 2012
Last updated
May 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jason Beauch, RPHNPI 1518380062
Title
Director of Pharmacy Managed Care
Phone
(616) 791-3169

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 60004404 IN
Community/Retail Pharmacy 3336C0003X 60004404 IN Primary

Addresses

Primary practice location

6309 Lima Rd
Fort Wayne, IN 46818-1425

Mailing address

2929 Walker Ave NW
Grand Rapids, MI 49544-6402
Phone (616) 791-5185

Other names 1

  • Meijer Pharmacy #124 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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…
O20120622000178 IN DME Supplier - PharmacyDME Supplier - Department StoreDME Supplier - Grocery Store 2062688971 Practice locations: Fort Wayne, IN

Other NPIs on the same Medicare enrollment 42

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 42

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
15D1008315Meijer Pharmacy 1246309 Lima Rd, Fort Wayne, IN 46818Certificate of waiverJan 15, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Meijer Stores Limited Partnership6309 Lima Rd, Fort Wayne, IN 46818-1425(260) 497-1010 Epoetin|Infusion 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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • Meijer Inc.

    dba Meijer Pharmacy #333

    • Community/Retail Pharmacy
    • Hillsdale, MI
    • NPI 1205698321

    Member Of

    NPD member

Practitioners & affiliated clinicians

Practitioners 1

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": "1326844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369872000000",
    "number": "1578834974",
    "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",
            "telephone_number": "616-791-5185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6309 LIMA RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468181425",
            "telephone_number": "260-497-1010",
            "fax_number": "260-497-1065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER STORES LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-18",
        "last_updated": "2013-05-30",
        "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_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IN",
            "license": "60004404",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60004404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #124",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2013; 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.