Provider Demographics
NPI:1639329881
Name:H-E-B, LP
Entity Type:Organization
Organization Name:H-E-B, LP
Other - Org Name:HEB PHARMACY #109
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 S 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:210-938-3182
Mailing Address - Fax:
Practice Address - Street 1:9710 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055
Practice Address - Country:US
Practice Address - Phone:713-647-5960
Practice Address - Fax:713-722-9146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
TX261323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26132OtherTSBP
TX4549892OtherNCPDP
TX468851Medicaid
TX26132OtherTSBP
TX4549892OtherNCPDP