NPIMap

Organization Active NPI

Meijer Stores Limited Partnership

Doing business as Meijer Pharmacy #332

  • Community/Retail Pharmacy
  • North Canton, OH
National Provider Identifier
1669234878
Registry record updated Jan 24, 2024
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 #332
Practice address
1505 North Main Street
North Canton, OH 44720
Phone
(234) 236-2610
Fax
(234) 236-2625
NPI assigned
Jan 24, 2024
Last updated
Jan 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2024

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

Authorized official

Name
Joseph Back
Title
Director of Managed Care Programs
Phone
(616) 791-3346

Specialties & licenses 2

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

Addresses

Primary practice location

1505 North Main Street
North Canton, OH 44720

Mailing address

2929 Walker Ave NW
Grand Rapids, MI 49544-6402

Other names 1

  • Meijer Pharmacy #332 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
O20250825001543 OH DME Supplier - PharmacyDME Supplier - Grocery StoreDME Supplier - Department Store 2062688971 Practice locations: North Canton, 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
36D2297670Meijer Pharmacy #3321505 N Main St, North Canton, OH 44720Certificate of waiverJan 18, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Meijer Pharmacy #3321505 North Main Street, North Canton, OH 44720-1668(234) 236-2610 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": "1706054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706054400000",
    "number": "1669234878",
    "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": "1505 NORTH MAIN STREET",
            "city": "NORTH CANTON",
            "state": "OH",
            "postal_code": "44720",
            "telephone_number": "234-236-2610",
            "fax_number": "234-236-2625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER STORES LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-24",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "BACK",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE PROGRAMS",
        "authorized_official_telephone_number": "616-791-3346"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #332",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2024; 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.