Provider Demographics
NPI:1891113973
Name:HY-VEE INC
Entity Type:Organization
Organization Name:HY-VEE INC
Other - Org Name:HY-VEE PHARMACY (1640)
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 1:2115 S MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4501
Practice Address - Country:US
Practice Address - Phone:217-726-1003
Practice Address - Fax:712-546-2567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL989110OtherMEDICARE MASS IMMUNIZATION
IL0213410290Medicare NSC