NPIMap

Meijer Stores Limited Partnership

Organization Active NPI Community/Retail Pharmacy · Fort Wayne, IN

NPI 1578834974 · NPPES record last updated May 30, 2013

Key facts

NPI
1578834974
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
60004404 (IN)
Legal business name
MEIJER STORES LIMITED PARTNERSHIP
Practice address
6309 Lima Rd
Fort Wayne, IN 46818-1425
Phone
(260) 497-1010
Fax
(260) 497-1065
NPI assigned
Jan 18, 2012
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 42

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

View all 42

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D1008315Meijer Pharmacy 124
6309 Lima Rd, Fort Wayne, IN 46818		Certificate of waiverJan 15, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Meijer Stores Limited Partnership
6309 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 assignment
Participating since Nov 23, 2011

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IN

Medicare enrollment records

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 - Pharmacy
DME Supplier - Department Store
DME Supplier - Grocery Store		 2062688971 Practice locations: Fort Wayne, IN

National Provider Directory

Tax ID family
Meijer Stores LP (105 organizations share this tax ID)

Specialties & licenses

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

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 identifiers

IdentifierTypeStateIssuer
201079240AMedicaidIN

Other names

  • Meijer Pharmacy #124 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 30, 2013.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201079240A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #124",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

All providers in Fort Wayne, IN · Community/Retail Pharmacy in Indiana

Sources for this page

Verify at the official NPI Registry.