NPIMap

Organization Active NPI

Hy-Vee Inc

  • Community/Retail Pharmacy
  • Bethany, MO
National Provider Identifier
1356378293
Registry record updated May 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
2001032650 Issued in MO
Legal business name
HY-VEE INC
Practice address
1104 S 25TH St
Bethany, MO 64424-2612
Phone
(660) 425-8171
Fax
(660) 425-8161
NPI assigned
Jun 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2026

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 2001032650 MO
Community/Retail Pharmacy 3336C0003X 2001032650 MO Primary
Long Term Care Pharmacy 3336L0003X 2001032650 MO

Addresses

Primary practice location

1104 S 25TH St
Bethany, MO 64424-2612

Mailing address

PO Box 850442
Minneapolis, MN 55485-0442
Phone (515) 267-2800

Other identifiers 3

IdentifierTypeStateIssuer
2634310OtherMONCPDP
625680806MedicaidMO
605680800MedicaidMO

Other names 1

  • Hy-Vee Pharmacy (1036) Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050301000077 MO Part B Supplier - Mass Immunization (Roster Biller Only) 7416855242 19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gladstone, MO; Warrensburg, MO; Trenton, MO; St Joseph, MO; Raytown, MO; Princeton, MO; Maryville, MO; Liberty, MO…
O20100930060277 MO DME Supplier - PharmacyDME Supplier - Grocery Store 7416855242 Practice locations: Bethany, MO

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Hy Vee Pharmacy (1036)1104 S 25TH St Box 47, Bethany, MO 64424-2612(660) 425-8171 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|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|N… Does not accept assignmentParticipating since Dec 7, 2017

National Provider Directory

National Provider Directory
Tax ID family
Drug Town 7060278 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Locations

1104 S 25th St
#47
Bethany, MO 64424
Phone (660) 425-8171

1104 S 25th St
Bethany, MO 64424
Phone (660) 425-8171

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778544000000",
    "number": "1356378293",
    "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": "1104 S 25TH ST",
            "city": "BETHANY",
            "state": "MO",
            "postal_code": "644242612",
            "telephone_number": "660-425-8171",
            "fax_number": "660-425-8161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HY-VEE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-27",
        "last_updated": "2026-05-12",
        "certification_date": "2026-05-12",
        "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": "MO",
            "license": "2001032650",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2001032650",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MO",
            "license": "2001032650",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2634310",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "625680806",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "605680800",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hy-Vee Pharmacy (1036)",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hy-Vee Pharmacy (1036)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bethany, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2026; 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.

Verify at the official NPI Registry.