Provider Information for 1134556277
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MEIJER GREAT LAKES LIMITED PARTNERSHIP
Other Names:Doing Business As:MEIJER PHARMACY #269Organization Subpart: NO
NPI: 1134556277
Last Updated: 2014-03-25
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Details
Name | Value | ||||||||||||
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NPI | 1134556277 | ||||||||||||
Enumeration Date | 2013-10-03 | ||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||
Status | Active | ||||||||||||
Authorized Official Information | Name: Mr. JASON BEAUCH R.Ph Title: Director of Pharmacy Managed Care Phone: 6167913169 | ||||||||||||
Mailing Address | 2929 WALKER AVE NW GRAND RAPIDS, MI 49544-6402 United States Phone: 616-791-3169 | Fax:616-735-8532 | ||||||||||||
Primary Practice Address | 3649 N. VERMILION ST. DANVILLE, IL 61832-1312 United States Phone: 217-655-7210 | Fax:217-655-7265 | ||||||||||||
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