Provider Demographics
NPI:1831482512
Name:HY-VEE INC
Entity Type:Organization
Organization Name:HY-VEE INC
Other - Org Name:HY-VEE PHARMACY #3 (1322)
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 850442
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55485-0442
Mailing Address - Country:US
Mailing Address - Phone:515-267-2800
Mailing Address - Fax:515-559-2593
Practice Address - Street 1:5330 NW 64TH STREET
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2414
Practice Address - Country:US
Practice Address - Phone:816-505-7163
Practice Address - Fax:816-505-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110197273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1831482512Medicaid
MO0213410272Medicare NSC