Provider Demographics
NPI:1639293889
Name:MEIJER PHARMACY #150
Entity type:Organization
Organization Name:MEIJER PHARMACY #150
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF PHARMACY OPERATIO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-791-3293
Mailing Address - Street 1:3911 W SR 22-3
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140
Mailing Address - Country:US
Mailing Address - Phone:513-583-2110
Mailing Address - Fax:513-583-2165
Practice Address - Street 1:3911 W SR 22-3
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140
Practice Address - Country:US
Practice Address - Phone:513-583-2110
Practice Address - Fax:513-583-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0281010Medicaid
OH0460780108Medicare ID - Type Unspecified