Provider Demographics
NPI:1174501035
Name:H.Y.M. INC.
Entity type:Organization
Organization Name:H.Y.M. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GROTHE
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:507-665-3301
Mailing Address - Street 1:204 VALLEY GREEN SQ
Mailing Address - Street 2:
Mailing Address - City:LE SUEUR
Mailing Address - State:MN
Mailing Address - Zip Code:56058-1915
Mailing Address - Country:US
Mailing Address - Phone:507-665-3301
Mailing Address - Fax:507-665-3304
Practice Address - Street 1:204 VALLEY GREEN SQ
Practice Address - Street 2:
Practice Address - City:LE SUEUR
Practice Address - State:MN
Practice Address - Zip Code:56058-1915
Practice Address - Country:US
Practice Address - Phone:507-665-3301
Practice Address - Fax:507-665-3304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:H.Y.M. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-02
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2610485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0757620001Medicare NSC