Provider Demographics
NPI:1013668870
Name:MEIJER STORES LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:MEIJER STORES LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER GOVERNMENT MANAGED GCARE
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:616-249-6272
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:616-735-8532
Practice Address - Street 1:4934 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2392
Practice Address - Country:US
Practice Address - Phone:234-804-0884
Practice Address - Fax:234-804-0875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies