Active NPI
Hy-Vee Inc
Doing business as Hy-Vee Pharmacy (1634)
- Community/Retail Pharmacy
- Storm Lake, IA
National Provider Identifier
1114963477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 1059
- Legal business name
- HY-VEE INC
- Doing business as
- Hy-Vee Pharmacy (1634)
- Practice address
- 1250 N. Lake Ave.
Storm Lake, IA 50588 - Phone
- (712) 732-1364
- Fax
- (712) 732-4645
- NPI assigned
- Jun 22, 2006
- Last updated
- Dec 9, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Angie Nelson
- Title
- Senior Vice President
- Phone
- (515) 267-2800
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 1059 | IA | |
| Community/Retail Pharmacy | 3336C0003X | 1059 | IA | Primary |
Addresses
Primary practice location
1250 N. Lake Ave.
Storm Lake, IA 50588
Mailing address
PO Box 850442
Minneapolis, MN 55485-0442
Phone (515) 267-2800
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0176909 | Medicaid | IA | |
| 1619468 | Other | IA | NCPDP |
Other names 1
- Hy-Vee Pharmacy (1634)
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031230000598 | IA | Part B Supplier - Mass Immunization (Roster Biller Only) | 7416855242 |
This NPI is an additional NPI on the enrollment Practice locations: Albia, IA |
| O20100930075719 | IA | DME Supplier - Pharmacy | 7416855242 | Practice locations: Storm Lake, IA |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 16D2001138 | Hy-Vee Pharmacy #1634 | Certificate of waiver | Dec 13, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Hy-Vee Pharmacy (1634) | Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Nebulizer Equipment and/o… | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Hy-Vee Pharmacy 1530
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
dba Hy-Vee Pharmacy Fulfillment Mail Order
- Mail Order Pharmacy
- Des Moines, IA
- NPI 1053958348
-
dba Hy-Vee Home Health Care & Medical Supply
- Oxygen Equipment & Supplies (DME)
- Muscatine, IA
- NPI 1104195411
Locations
1250 Lake Ave
Storm Lake, IA 50588
Phone (712) 732-1364
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1733702400000",
"number": "1114963477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 850442",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554850442",
"telephone_number": "515-267-2800",
"fax_number": "515-559-2593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 N. LAKE AVE.",
"city": "STORM LAKE",
"state": "IA",
"postal_code": "50588",
"telephone_number": "712-732-1364",
"fax_number": "712-732-4645"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HY-VEE INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-22",
"last_updated": "2024-12-09",
"certification_date": "2024-12-09",
"status": "A",
"authorized_official_last_name": "NELSON",
"authorized_official_first_name": "ANGIE",
"authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
"authorized_official_telephone_number": "515-267-2800"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "IA",
"license": "1059",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "IA",
"license": "1059",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0176909",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "1619468",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Hy-Vee Pharmacy (1634)",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Hy-Vee Pharmacy (1634)",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Storm Lake, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.