Healthcare Provider Details

I. General information

NPI: 1780552182
Provider Name (Legal Business Name): HEB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9255 GRISSOM RD
SAN ANTONIO TX
78251-2805
US

IV. Provider business mailing address

12707 JASPER LEAF
SAN ANTONIO TX
78253-5533
US

V. Phone/Fax

Practice location:
  • Phone: 210-680-2958
  • Fax:
Mailing address:
  • Phone: 210-289-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KAYLA MARIE FUEHRMANN
Title or Position: PHARMACY INTERN
Credential:
Phone: 210-289-6126