Provider Demographics
NPI:1891975033
Name:HY-VEE INC
Entity Type:Organization
Organization Name:HY-VEE INC
Other - Org Name:HY-VEE CLINIC PHARMACY (1634)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:EGELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-453-2784
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-0061
Mailing Address - Country:US
Mailing Address - Phone:712-225-1903
Mailing Address - Fax:712-225-5700
Practice Address - Street 1:606 LAKE AVE
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-1852
Practice Address - Country:US
Practice Address - Phone:712-732-5067
Practice Address - Fax:712-732-4039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA616332B00000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1891975033Medicaid
IA16-23239OtherNCPDP
IA0213410247Medicare NSC
IAI0232Medicare PIN