Healthcare Provider Details

I. General information

NPI: 1356378293
Provider Name (Legal Business Name): HY-VEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 S 25TH ST
BETHANY MO
64424-2612
US

IV. Provider business mailing address

PO BOX 850442
MINNEAPOLIS MN
55485-0442
US

V. Phone/Fax

Practice location:
  • Phone: 660-425-8171
  • Fax: 660-425-8161
Mailing address:
  • Phone: 515-267-2800
  • Fax: 515-559-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2001032650
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2001032650
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2001032650
License Number StateMO

VIII. Authorized Official

Name: ANGIE NELSON
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 515-267-2800