Meijer Stores Limited Partnership

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MEIJER STORES LIMITED PARTNERSHIP

Doing business as

Meijer Pharmacy #320

Practice address

1400 Boardman Canfield Rd.
Boardman, OH 44512-4007

Phone

(234) 287-3010

Fax

(234) 287-3034

NPI assigned

Feb 19, 2021

Last updated

Feb 19, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Raymond F Burzynski

Title

Director of Managed Care

Phone

(616) 249-6583

Specialties & licenses 2

Addresses

Other names 1

• Meijer Pharmacy #320 Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 2

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.

• Samah Amin Abdallah

  • Pharmacist
  • Boardman, OH
  • NPI 1689410433
  NPD
• Leah Rohan

  • Pharmacist
  • Boardman, OH
  • NPI 1891570479
  NPD

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

{
    "created_epoch": "1613692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613692800000",
    "number": "1629661699",
    "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": "616-791-3485",
            "fax_number": "616-735-8532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 BOARDMAN CANFIELD RD.",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445124007",
            "telephone_number": "234-287-3010",
            "fax_number": "234-287-3034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER STORES LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-19",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-02",
        "status": "A",
        "authorized_official_last_name": "BURZYNSKI",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE",
        "authorized_official_telephone_number": "616-249-6583"
    },
    "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #320",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Medical Imaging Network Inc. (Breasr Care Center/MammoVan/Transportable)
• Medical Service Company
• Abbie Lynn Medovich, PA-C
• Gina Meenachan
• Adam Meese
• Melissa Mullane Padgett, DDS, LLC
• Derek Mellott, O.D.
• Richard A Memo, M.D.
• Eugene Mennow II, D.C
• Brisha Merchant

• Community/Retail Pharmacy in Boardman, OH
• Providers in Boardman, OH by specialty
• Community/Retail Pharmacy in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; 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.