Healthcare Provider Details

I. General information

NPI: 1366551442
Provider Name (Legal Business Name): LIN'S SUPERMARKETS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N MAIN ST
CEDAR CITY UT
84720-2637
US

IV. Provider business mailing address

PO BOX 26417
SLC UT
84126-0417
US

V. Phone/Fax

Practice location:
  • Phone: 435-865-6665
  • Fax: 435-867-4880
Mailing address:
  • Phone: 801-978-8225
  • Fax: 801-978-8634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number369336-1703
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHAWNA K HANSON
Title or Position: DIRECTOR OF PHARMACY OPERATIONS
Credential:
Phone: 801-978-8309