| Organization Name: | MEIJER GREAT LAKES LIMITED PARTNERSHIP |
| NPI Number: | 1215207006 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JASON BEAUCH (DIRECTOR OF PHARMACY MANAGED CARE) |
| Mailing Address: | 2401 N Prospect Ave Champaign |
| State: | IL US |
| Postal Code: | 618221233 |
| Phone Number: | 2173534010 |
| Fax Number: | 2173534065 |
| NPI Enumeration Date: | 01/10/2012 |
| NPI Last Update Date: | 03/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 054011966 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |