Provider Demographics
NPI:1578590006
Name:HY-VEE INC
Entity Type:Organization
Organization Name:HY-VEE INC
Other - Org Name:HY-VEE PHARMACY (1384)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-267-2800
Mailing Address - Street 1:PO BOX 310442
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50331-0442
Mailing Address - Country:US
Mailing Address - Phone:515-267-2800
Mailing Address - Fax:515-559-2593
Practice Address - Street 1:109 NORTH BLUE JAY DRIVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1906
Practice Address - Country:US
Practice Address - Phone:816-792-4632
Practice Address - Fax:816-792-1429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5780332B00000X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO607860509Medicaid
MO2629535OtherNCPDP
MO0213410084Medicare NSC
MO9007094Medicare PIN