Active NPI
Meijer Inc
Doing business as Meijer Pharmacy #065
- Community/Retail Pharmacy
- Shelby Township, MI
National Provider Identifier
1669512174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 5301005163
- Legal business name
- MEIJER INC
- Doing business as
- Meijer Pharmacy #065
- Practice address
- 15055 Hall Rd
Shelby Township, MI 48315-6206 - Phone
- (586) 566-4110
- Fax
- (586) 566-4165
- NPI assigned
- Feb 7, 2007
- Last updated
- Mar 17, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jason Beauch, RPH
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 5301005163 | MI | |
| Community/Retail Pharmacy | 3336C0003X | 5301005163 | MI | Primary |
Addresses
Primary practice location
15055 Hall Rd
Shelby Township, MI 48315-6206
Mailing address
2929 Walker Ave NW
Grand Rapids, MI 49544-9424
Phone (616) 791-3169
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2345014 | Medicaid | MI |
Other names 1
- Meijer Pharmacy #065
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071022000424 | MI | Part B Supplier - Mass Immunization (Roster Biller Only) | 8325015639 | This NPI is an additional NPI on the enrollment |
| O20100930089315 | MI | DME Supplier - Pharmacy | 8325015639 | Practice locations: Shelby Township, MI |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Meijer Inc | Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Meijer
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.
Locations
15055 Hall Rd
Shelby Township, MI 48315
Phone (586) 566-4110
Practitioners & affiliated clinicians
Practitioners 5
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.
-
- Pharmacist
- Grand Rapids, MI
- NPI 1518380062
-
- Pharmacotherapy Pharmacist
- Shelby Township, MI
- NPI 1962813683
-
- Pharmacotherapy Pharmacist
- Shelby Township, MI
- NPI 1215347877
-
- Pharmacotherapy Pharmacist
- Shelby Township, MI
- NPI 1548670987
-
- Pharmacotherapy Pharmacist
- Shelby Township, MI
- NPI 1902217037
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1395014400000",
"number": "1669512174",
"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": "15055 HALL RD",
"city": "SHELBY TOWNSHIP",
"state": "MI",
"postal_code": "483156206",
"telephone_number": "586-566-4110",
"fax_number": "586-566-4165"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEIJER INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-07",
"last_updated": "2014-03-17",
"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": "MI",
"license": "5301005163",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MI",
"license": "5301005163",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2345014",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Meijer Pharmacy #065",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Shelby Township, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.