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Provider Information for 1285012815


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H-E-B, LP

Other Names:  
Doing Business As: 
HEB PHARMACY #714

Organization Subpart: NO

NPI: 1285012815
Last Updated: 2020-09-24
Certification Date: 2020-09-24

Details

NameValue
NPI1285012815
Enumeration Date2015-05-15
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: DAVID LIENDO
Title: Government Programs Manager
Phone: 2109383182
Mailing Address 646 SOUTH FLORES
SAN ANTONIO, TX 78204
United States

Phone: 210-938-3182 | Fax:
 
Primary Practice Address 2000 RANCH RD. 620 SOUTH STE A
LAKEWAY, TX 78734
United States

Phone: 512-263-8481 | Fax:512-599-5883
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)TX30082Texas State Board of Pharmacy
MEDICAIDTX469624
Other (non-Medicare)TX5916626NCPDP
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 291U00000X - Clinical Medical Laboratory
Yes 3336C0003X - Pharmacy - Community/Retail Pharmacy