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MEIJER GREAT LAKES LIMITED PARTNERSHIP NPI 1215207006


NPI Information

NPI: 1215207006
Provider Name: MEIJER GREAT LAKES LIMITED PARTNERSHIP

Doing Business As: MEIJER PHARMACY #146

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 14D1016614

Address:
2401 N PROSPECT AVE
CHAMPAIGN, IL
ZIP 61822
Phone: (217) 353-4010
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MEIJER GREAT LAKES LIMITED PARTNERSHIP is a community/retail pharmacy pharmacy in Champaign, IL. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. MEIJER GREAT LAKES LIMITED PARTNERSHIP NPI is 1215207006. The provider is registered as an organization entity type.
The provider Is Doing Business As Meijer Pharmacy #146.

The provider's business location address is:

2401 N PROSPECT AVE
CHAMPAIGN, IL
ZIP 61822-233
Phone: (217) 353-4010
Fax: (217) 353-4065

The provider's authorized official is Jason Beauch .
The authorized official title is Director Of Pharmacy Managed Care and has the following contact phone number (616) 791-3169.

The CLIA number assigned to this NPI record is 14D1016614 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/10/2012 and was last updated on 3/21/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1332B00000XDurable Medical Equipment & Medical Supplies054011966ILLINOISNo
23336C0003XPharmacyCommunity/Retail Pharmacy054011966ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
16507510019MEDICARE NSCILLINOIS
2IL7525MEDICARE PINILLINOIS
3=========018MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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