Provider Demographics
NPI:1205866803
Name:HY-VEE INC
Entity Type:Organization
Organization Name:HY-VEE INC
Other - Org Name:HY-VEE PHARMACY #2 (1561)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST. VICE PRESIDENT, PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:EGELAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:515-453-2784
Mailing Address - Street 1:5820 WESTOWN PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8223
Mailing Address - Country:US
Mailing Address - Phone:515-453-2784
Mailing Address - Fax:515-327-2162
Practice Address - Street 1:6495 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-2745
Practice Address - Country:US
Practice Address - Phone:913-962-1818
Practice Address - Fax:913-962-2147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS89073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100433480AMedicaid
KS0213410133Medicare NSC