Provider Demographics
NPI:1003030636
Name:H-E-B, LP
Entity Type:Organization
Organization Name:H-E-B, LP
Other - Org Name:HEB PHARMACY #094
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GOVERNMENT PROGRAMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LIENDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-938-3182
Mailing Address - Street 1:646 SOUTH FLORES
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2409 E INTERSTATE HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-1007
Practice Address - Country:US
Practice Address - Phone:956-205-6755
Practice Address - Fax:956-205-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X, 332B00000X
TX254473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No291U00000XLaboratoriesClinical Medical Laboratory
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4544171OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX468852Medicaid
870024008Medicare PIN
4399020212Medicare NSC
4544171OtherNCPDP PROVIDER IDENTIFICATION NUMBER