Hy-Vee Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

877 Issued in IA

Legal business name

HY-VEE INC

Doing business as

Hy-Vee Pharmacy #1 (1105)

Practice address

3019 Rockingham Rd
Davenport, IA 52802-2065

Phone

(563) 322-7573

Fax

(563) 322-3017

NPI assigned

Jun 23, 2006

Last updated

Oct 4, 2023By the provider in NPPES

Organization subpart

No

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

Addresses

Other identifiers 2

Other names 1

• Hy-Vee Pharmacy #1 (1105) Doing business as

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ama Asantewaa Agyabeng, PHARMD

  • Pharmacist
  • Davenport, IA
  • NPI 1780340760
  NPD (past)
• Brett A Anderson, R.PH.

  • Pharmacist
  • Davenport, IA
  • NPI 1487780359
  NPD (past)
• Diana Lynn Burnett, PHAR M D

  • Pharmacist
  • Davenport, IA
  • NPI 1265576714
  NPD (past)
• Thomas M Cook, RPH

  • Pharmacist
  • Davenport, IA
  • NPI 1851418818
  NPD (past)
• Jeff Lafrenz

  • Pharmacist
  • Davenport, IA
  • NPI 1043842248
  NPD (past)

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1992731160",
    "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": "3019 ROCKINGHAM RD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528022065",
            "telephone_number": "563-322-7573",
            "fax_number": "563-322-3017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HY-VEE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-23",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "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": "877",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1614569",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0233908",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hy-Vee Pharmacy #1 (1105)",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hy-Vee Pharmacy #1 (1105)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hy-Vee Inc (Hy-Vee Pharmacy #3 (1107))
• Hy-Vee Inc (Hy-Vee Pharmacy #2 (1106))
• Hy-Vee Inc (Hy-Vee Pharmacy #5 (1109))
• Hy-Vee Inc (Hy-Vee Pharmacy #4 (1108))
• Hy-Vee Inc (Hy-Vee Pharmacy Fulfillment Center (4068))
• Nathaniel Hyatt, DMD
• Roger Jonathan Hynes, D.C.
• Ebehireme E Ibazebo, M.D
• Kelsey Ibeawuchi, PHARMD
• Ideal Health and Wellness, SC (Ideal Health and Wellness, SC, Corp)

• Community/Retail Pharmacy in Davenport, IA
• Providers in Davenport, IA by specialty
• Community/Retail Pharmacy in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.