Provider Demographics
NPI:1225669641
Name:MEIJER GREAT LAKES LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:MEIJER GREAT LAKES LIMITED PARTNERSHIP
Other - Org Name:MEIJER PHARMACY #313
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:BURZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-249-6583
Mailing Address - Street 1:2929 WALKER AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-6402
Mailing Address - Country:US
Mailing Address - Phone:616-791-3485
Mailing Address - Fax:
Practice Address - Street 1:541 PURI PKWY
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-9029
Practice Address - Country:US
Practice Address - Phone:815-991-1210
Practice Address - Fax:815-991-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies