NPIMap

Organization Active NPI

Meijer Great Lakes Limited Partnership

Doing business as Meijer Pharmacy #258

  • Community/Retail Pharmacy
  • Richmond, KY
National Provider Identifier
1689991176
Registry record updated Mar 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
P07390 Issued in KY
Legal business name
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Doing business as
Meijer Pharmacy #258
Practice address
2013 Lantern Ridge Dr
Richmond, KY 40475-6010
Phone
(859) 575-5010
Fax
(859) 575-5065
NPI assigned
Apr 23, 2010
Last updated
Mar 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2014

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

Authorized official

Name
Mr. Jason Beauch, RPHNPI 1518380062
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)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X P07390 KY
Community/Retail Pharmacy 3336C0003X P07390 KY Primary

Addresses

Primary practice location

2013 Lantern Ridge Dr
Richmond, KY 40475-6010

Mailing address

2929 Walker Ave NW
Grand Rapids, MI 49544-6402
Phone (616) 791-3169

Other identifiers 1

IdentifierTypeStateIssuer
7100211710MedicaidKY

Other names 1

  • Meijer Pharmacy #258 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110907001155 KY DME Supplier - PharmacyDME Supplier - Department StoreDME Supplier - Grocery Store 4385829480 Practice locations: Richmond, KY
O20130305000271 KY Part B Supplier - Mass Immunization (Roster Biller Only) 4385829480 10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Florence, KY; Richmond, KY; Owensboro, KY; Louisville, KY; Lexington, KY; Cold Spring, KY; Bowling Green, KY

Other NPIs on the same Medicare enrollment 10

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

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Meijer Great Lakes Limited Partners2013 Lantern Ridge Drive, Richmond, KY 40475-6010(859) 575-5010 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 assignmentParticipating since Jan 1, 2023

National Provider Directory

National Provider Directory
Tax ID family
Meijer Great Lakes LTD PT37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

Locations

2013 Lantern Ridge Dr
Richmond, KY 40475
Phone (859) 575-5000

Practitioners & affiliated clinicians

Practitioners 6

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": "1271980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395705600000",
    "number": "1689991176",
    "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": "616-791-3169",
            "fax_number": "616-735-8532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2013 LANTERN RIDGE DR",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "404756010",
            "telephone_number": "859-575-5010",
            "fax_number": "859-575-5065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER GREAT LAKES LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-23",
        "last_updated": "2014-03-25",
        "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_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "KY",
            "license": "P07390",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "P07390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100211710",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #258",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richmond, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.