MEIJER PHARMACY #107 NPI 1265597041
Pharmacy - Community/Retail Pharmacy in Fairborn, OH

Organization Pharmacy Community/Retail Pharmacy Medicare Supplier Accepts Medicare Approved Payment CLIA Number 36D0987602 CLIA Certificate of Waiver

About MEIJER PHARMACY #107

Meijer Pharmacy #107 is a provider established in Fairborn, Ohio specializing in Pharmacy with a focus in community/retail pharmacy . The NPI number of Meijer Pharmacy #107 is 1265597041 and was assigned on December 2006. The practitioner's primary taxonomy code is 3336C0003X with license number 02687850 (OH). The provider is registered as an organization and their NPI record was last updated 9 years ago. The provider's is doing business as Meijer Pharmacy #107. The authorized official of this NPI record is Jason Beauch R.ph (Director Of Pharmacy Managed Care)

NPI
1265597041
Provider NameMEIJER PHARMACY #107
Provider Location Address3822 COLONEL GLENN HWY FAIRBORN, OH 45324
Provider Mailing Address2929 WALKER AVE NW GRAND RAPIDS, MI 49544
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameMEIJER PHARMACY #107
Other Name TypeDoing Business As (3)
Enumeration Date12-22-2006
Last Update Date03-17-2014



Meijer Pharmacy #107 is a medicare supplier with PTAN 6685160042 who accepts Medicare assignment for all durable medical equipment and supplies. The provider accepts the Medicare allowable as payment in full.The supplier carries the following product categories: Epoetin or Immunosuppressive Drugs or Infusion Drugs or Nebulizer Drugs or Oral Anticancer Drugs or Oral Antiemetic Drugs or Blood Glucose Monitors/Supplies (Non-Mail Order) or Canes and/or Crutches or Walkers.

The CLIA number of Meijer Pharmacy #107 is 36D0987602 registered as a "pharmacy" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Meijer Pharmacy #107 to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.



Primary Taxonomy

Taxonomy Code3336C0003X
ClassificationPharmacy
TypeSuppliers
SpecializationCommunity/Retail Pharmacy
License No.02687850
License StateOH
Taxonomy DescriptionA 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.

Business Address

MEIJER PHARMACY #107
3822 COLONEL GLENN HWY
FAIRBORN, OH
ZIP 45324
Phone: (937) 427-6110
Fax: (937) 427-6165

Get Directions


Mailing Address

MEIJER PHARMACY #107
2929 WALKER AVE NW
GRAND RAPIDS, MI
ZIP 49544
Phone: (616) 791-3169
Fax: (616) 735-8532


Authorized Official

Authorized Official Name JASON BEAUCH R.PH
Authorized Official TitleDIRECTOR OF PHARMACY MANAGED CARE
Authorized Official Phone(616) 791-3169

Medical Equipment Supplier

The provider carries the following medical supplies product categories:

PTAN6685160042
Accepts Medicare AssignmentYES
Specialities ListPharmacy, Department Store, Grocery Store.
Supplies List
  • Epoetin - Epoetin is a man-made version of human erythropoietin (EPO)
  • Immunosuppressive Drugs - Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
  • Infusion Drugs -
  • Nebulizer Drugs - Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
  • Oral Anticancer Drugs - FDA anticancer drugs
  • Oral Antiemetic Drugs - FDA antiemetic drugs
  • Blood Glucose Monitors/Supplies (Non-Mail Order) - Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
  • Canes and/or Crutches - Standard Canes, Quad Canes, Offset Canes, Standard Crutches, Forearm Crutches
  • Walkers - Standard Walkers, Wheeled Walkers, Folding Walker
Competitive BiddingNO

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1265597041 is:

CLIA Number36D0987602
Facility TypePHARMACY
Certificate TypeCertificate of Waiver

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1332B00000XSuppliersDurable Medical Equipment & Medical Supplies02687850MINo

Taxonomy Description: a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
0869323MEDICAID (05)OH
H191610MEDICARE PIN (08)
6685160042MEDICARE NSC (07)OH

NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1265597041
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
221251091408
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 2 + 1 + 2 + 5 + 1 + 0 + 9 + 1 + 4 + 0 + 8 + 24 = 59
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 59 = 11

The NPI number 1265597041 is valid because the calculated check digit 1 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1821412008MRS. KIMBERLY BROWN RPH
Individual
Pharmacist3822 COLONEL GLENN HWY
FAIRBORN, OH 45324
(937) 426-3600
1528483047 HEATHER LUKENS RPH
Individual
Pharmacist3822 COLONEL GLENN HWY
FAIRBORN, OH 45324
(937) 426-3600

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
Meijer Pharmacy #107 is registered as an entity type code: 2. The entity type code describes the type of health care provider that is being assigned an NPI. The entity type codes are:

  • 1 = Person: individual human being who furnishes health care.
  • 2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.