Provider Demographics
NPI:1902972847
Name:HY-VEE INC
Entity Type:Organization
Organization Name:HY-VEE INC
Other - Org Name:HY-VEE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:AKIRA
Authorized Official - Last Name:CUESTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:515-278-0117
Mailing Address - Street 1:3994 NW URBANDALE DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-7922
Mailing Address - Country:US
Mailing Address - Phone:515-278-0117
Mailing Address - Fax:515-278-6165
Practice Address - Street 1:3994 NW URBANDALE DR
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-7922
Practice Address - Country:US
Practice Address - Phone:515-278-0117
Practice Address - Fax:515-278-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0298463Medicaid
IA02134102007Medicare NSC