Provider Demographics
NPI:1073830659
Name:H-E-B, LP
Entity Type:Organization
Organization Name:H-E-B, LP
Other - Org Name:HEB PHARMACY #612
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:SOUTH 1/PHARMACY
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 1:14414 US HIGHWAY 87 WEST
Practice Address - Street 2:
Practice Address - City:LAVERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121
Practice Address - Country:US
Practice Address - Phone:830-779-3109
Practice Address - Fax:830-779-4190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
TX268633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4555415OtherNCPDP
TX469494Medicaid
TX26863OtherTEXAS STATE BOARD OF PHARMACY
TX4555415OtherNCPDP
TX26863OtherTEXAS STATE BOARD OF PHARMACY