Meijer, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301010344 Issued in MI

Legal business name

MEIJER, INC.

Doing business as

Meijer Pharmacy #271

Practice address

1223 Phoenix St.
South Haven, MI 49090-7911

Phone

(269) 639-3510

Fax

(269) 639-3565

NPI assigned

Mar 10, 2014

Last updated

Jun 10, 2014By 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

Mr. Jason Beauch, R.PHNPI 1518380062

Title

Director of Pharmacy Managed Care

Phone

(616) 791-3169

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Meijer Pharmacy #271 Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

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

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.

• Jason John Beauch, R.PH.

  • Pharmacist
  • Grand Rapids, MI
  • NPI 1518380062
  Authorized official Same address or phone
• Randy J Bergsma, PHARM.D

  • Pharmacotherapy Pharmacist
  • South Haven, MI
  • NPI 1093225708
  NPD (past)
• Laura J. Lau, PHARM.D.

  • Pharmacist
  • South Haven, MI
  • NPI 1487765061
  NPD (past)
• Randy Scott Tourchette, PHARM. D

  • Pharmacist
  • South Haven, MI
  • NPI 1467062885
  NPD (past)
• Daniel Robert Worthington, PHARM.D.

  • Pharmacotherapy Pharmacist
  • South Haven, MI
  • NPI 1790137347
  NPD (past)

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

{
    "created_epoch": "1394409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402358400000",
    "number": "1881010205",
    "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": "1223 PHOENIX ST.",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490907911",
            "telephone_number": "269-639-3510",
            "fax_number": "269-639-3565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-10",
        "last_updated": "2014-06-10",
        "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": "R.PH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "5301010344",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301010344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881010205",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #271",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sharon Massey
• Ronald Maxwell Masters, D.C.
• Max Masters DC PLLC
• Christin M McFadyen, LPC
• Sandeep Maganlal Mehta, RPH
• Kathleen M Miles
• Addison Miller
• Brice J Miller, PA-C
• MJR Wellness Counseling, PLLC
• Brett Moor

• Community/Retail Pharmacy in South Haven, MI
• Providers in South Haven, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.