=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295844306
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIN'S SUPERMARKETS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 11/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 S MOAPA VALLEY BLVD
-----------------------------------------------------
City | OVERTON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-397-2308
-----------------------------------------------------
Fax | 702-397-2348
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 26417
-----------------------------------------------------
City | SLC
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84126-0417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-978-8225
-----------------------------------------------------
Fax | 801-978-8634
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY OPERATIONS
-----------------------------------------------------
Name | SHAWNA K HANSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 801-978-8309
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 1003355-325
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------