NPIMap

Organization Active NPI

Meijer Stores Limited Partnership

  • Community/Retail Pharmacy
  • Rossford, OH
National Provider Identifier
1629133566
Registry record updated Mar 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
021440900 Issued in OH
Legal business name
MEIJER STORES LIMITED PARTNERSHIP
Practice address
10055 Olde US 20
Rossford, OH 43460
Phone
(419) 873-4110
Fax
(419) 873-4165
NPI assigned
Dec 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2014

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

Authorized official

Name
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 021440900 OH
Community/Retail Pharmacy 3336C0003X 021440900 OH Primary

Addresses

Primary practice location

10055 Olde US 20
Rossford, OH 43460

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
2495036MedicaidOH

Other names 1

  • Meijer Pharmacy #211 Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120620000858 OH DME Supplier - PharmacyDME Supplier - Grocery StoreDME Supplier - Department Store 2062688971 1 other NPI on this enrollment
Practice locations: Rossford, OH
O20130605000647 OH Part B Supplier - Mass Immunization (Roster Biller Only) 2062688971 This NPI is an additional NPI on the enrollment

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
36D1028267Meijer Pharmacy #21110055 Olde US 20, Rossford, OH 43460Certificate of waiverJul 20, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Meijer Pharmacy # 21110055 Olde US 20, Rossford, OH 43460-1729(419) 873-4110 Epoetin|Immunosuppressive Drugs|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 LP105 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

NPI Registry JSON

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395619200000",
    "number": "1629133566",
    "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": "10055 OLDE US 20",
            "city": "ROSSFORD",
            "state": "OH",
            "postal_code": "43460",
            "telephone_number": "419-873-4110",
            "fax_number": "419-873-4165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER STORES LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2014-03-24",
        "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": "R.PH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OH",
            "license": "021440900",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "021440900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2495036",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #211",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rossford, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 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.