Provider Demographics
NPI:1679682090
Name:H-E-B, LP
Entity Type:Organization
Organization Name:H-E-B, LP
Other - Org Name:HEB FULLMENT CENTER
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 1:6520 FRATT RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-4486
Practice Address - Country:US
Practice Address - Phone:210-938-9734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21062OtherTSBP
TX467056Medicaid
4513520OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX4399020267Medicare NSC
730000011Medicare PIN
TX21062OtherTSBP