Meijer Stores Limited Partnership
Organization Active NPI Community/Retail Pharmacy · Jeffersonville, IN
NPI 1982975207 · NPPES record last updated Mar 24, 2014
Key facts
- NPI
- 1982975207
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 60005410 (IN)
- Legal business name
- MEIJER STORES LIMITED PARTNERSHIP
- Practice address
- 2750 Allison LN
Jeffersonville, IN 47130-5952 - Phone
- (812) 218-6610
- Fax
- (812) 218-6665
- NPI assigned
- Jan 18, 2012
- Organization subpart
- No
Authorized official
- Name
- Mr. Jason Beauch, RPH
- Title
- Director of Pharmacy Managed Care
- Phone
- (616) 791-3169
Other NPIs on the same Medicare enrollment 42
Corporate family (same tax ID) 13
Member of 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D1008260 | Meijer Pharmacy #167 | Certificate of waiver | Jan 14, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Meijer Pharmacy #167 |
Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111227000308 | IN | Part B Supplier - Mass Immunization (Roster Biller Only) | 2062688971 |
42 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lafayette, IN; New Albany, IN; Muncie, IN; Mishawaka, IN; Michigan City, IN; Merrillville, IN; McCordsville, IN; Marion, IN… |
| O20120626000767 | IN | DME Supplier - Pharmacy |
2062688971 | Practice locations: Jeffersonville, IN |
National Provider Directory
- Tax ID family
- Meijer Stores LP
Locations
2750 Allison Ln
Jeffersonville, IN 47130
Phone (812) 218-6610
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 60005410 | IN | |
| Community/Retail Pharmacy | 3336C0003X | 60005410 | IN | Yes |
Addresses
Primary practice location
2750 Allison LN
Jeffersonville, IN 47130-5952
Mailing address
2929 Walker Ave NW
Grand Rapids, MI 49544-6402
Phone (616) 791-3169
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201079650A | Medicaid | IN | |
| 54034608 | Medicaid | KY |
Other names
- Meijer Pharmacy #167
Other providers in Jeffersonville, IN
- Robert L McQuady Jr.
- Lisa Luan McSpadden
- Yudisley Machado Medina
- Medsavvy Solutions LLC
- Henry Nicholas Meiers
- Carolyn Nickole Meiman
- Cynthia Melton
- Mes Counseling LLC
- Metro Anesthesia Consultants, LLC
- Metro Specialty Surgery Center, LLC
All providers in Jeffersonville, IN · Community/Retail Pharmacy in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 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.