MEDICARE: LIN'S SUPERMARKETS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	369336-1703	UT

General Provider Information

NPI Number	:	1366551442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIN'S SUPERMARKETS INC

Provider Business Mailing Address
First Line	:	PO BOX 26417
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84126-0417
Country	:	US
Telephone Number	:	801-978-8225
Fax Number	:	801-978-8634

Provider Business Practice Location Address
First Line	:	150 N MAIN ST
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-2637
Country	:	US
Telephone Number	:	435-865-6665
Fax Number	:	435-867-4880

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY OPERATIONS
Name	:	SHAWNA K HANSON
Credential	:
Telephone Number	:	801-978-8309

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/24/2019

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Directions to “LIN'S SUPERMARKETS INC ” Practice Location

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