Meijer Inc
Organization Active NPI Community/Retail Pharmacy · Allen Park, MI
NPI 1730201427 · NPPES record last updated Mar 26, 2014
Key facts
- NPI
- 1730201427
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 5301008595 (MI)
- Legal business name
- MEIJER INC
- Practice address
- 3565 Fairlane Dr.
Allen Park, MI 48101 - Phone
- (313) 253-1110
- Fax
- (313) 253-1165
- NPI assigned
- Apr 4, 2007
- Organization subpart
- No
Authorized official
- Name
- Jason Beauch, RPH
- Title
- Director of Pharmacy Managed Care
- Phone
- (616) 791-3169
Corporate family (same tax ID) 24
Practitioners 2
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D1067236 | Meijer Pharmacy #233 | Certificate of waiver | Apr 12, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Meijer Pharmacy #233 |
Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Surgical Dressings | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Medicare enrollment records
| 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 |
| O20100930031691 | MI | DME Supplier - Pharmacy |
8325015639 | Practice locations: Allen Park, MI |
National Provider Directory
- Tax ID family
- Meijer
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 5301008595 | MI | |
| Community/Retail Pharmacy | 3336C0003X | 5301008595 | MI | Yes |
Addresses
Primary practice location
3565 Fairlane Dr.
Allen Park, MI 48101
Mailing address
2929 Walker Ave NW
Grand Rapids, MI 49544-9424
Phone (616) 791-3169
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2369571 | Medicaid | MI |
Other names
- Meijer Pharmacy #233
Other providers in Allen Park, MI
- Lisa Ruth McLean
- Medical Transportation of Michigan
- Medworks Urgent Care PLLC
- Kelly Meeker
- Ali H Mehram
- Metropolitan Urology, P.C.
- Ashley Miazga
- Michigan Bio Tech Partners, LLC
- Michigan Healthcare Professionals, P.C.
- April Miles
All providers in Allen Park, MI · Community/Retail Pharmacy in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.