1205866803 NPI number — HY-VEE INC

Table of content: (NPI 1205866803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205866803 NPI number — HY-VEE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HY-VEE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HY-VEE PHARMACY #2 (1561)
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205866803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5820 WESTOWN PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50266-8223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-453-2784
Provider Business Mailing Address Fax Number:
515-327-2162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6495 QUIVIRA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAWNEE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66216-2745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-962-1818
Provider Business Practice Location Address Fax Number:
913-962-2147
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EGELAND
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
ASST. VICE PRESIDENT, PHARMACY
Authorized Official Telephone Number:
515-453-2784

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  8907 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100433480A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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