Provider Demographics
NPI:1417280702
Name:LIN'S SUPERMARKETS INC
Entity Type:Organization
Organization Name:LIN'S SUPERMARKETS INC
Other - Org Name:LIN'S SUPERMARKETS INC #8
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:KIP
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-978-8309
Mailing Address - Street 1:PO BOX 26908
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84126-0908
Mailing Address - Country:US
Mailing Address - Phone:801-978-8225
Mailing Address - Fax:801-978-8634
Practice Address - Street 1:250 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2559
Practice Address - Country:US
Practice Address - Phone:435-896-5759
Practice Address - Fax:435-896-5844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7442363-1703333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1417280702Medicaid
2121824OtherPK