Provider Demographics
NPI:1992030894
Name:H-E-B, LP
Entity Type:Organization
Organization Name:H-E-B, LP
Other - Org Name:HEB PHARMACY #610
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 1:2121 FM 2920 RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3412
Mailing Address - Country:US
Mailing Address - Phone:281-907-7950
Mailing Address - Fax:281-528-9615
Practice Address - Street 1:2121 FM 2920 RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388
Practice Address - Country:US
Practice Address - Phone:281-907-7950
Practice Address - Fax:281-528-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX266333336C0003X
FH16725733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4554223OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX469124Medicaid
PH0667Medicare PIN