Healthcare Provider Details

I. General information

NPI: 1639288079
Provider Name (Legal Business Name): H-E-B, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 E MAIN ST
EAGLE PASS TX
78852
US

IV. Provider business mailing address

646 SOUTH FLORES
SAN ANTONIO TX
78204
US

V. Phone/Fax

Practice location:
  • Phone: 830-773-0420
  • Fax: 830-757-5752
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number21207
License Number StateTX

VIII. Authorized Official

Name: DAVID LIENDO
Title or Position: GOVERNMENT PROGRAMS MANAGER
Credential:
Phone: 210-938-3182