Healthcare Provider Details

I. General information

NPI: 1699217513
Provider Name (Legal Business Name): H-E-B, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20311 CHAMPION FOREST DRIVE
SPRING TX
77379
US

IV. Provider business mailing address

646 SOUTH FLORES ST
SAN ANTONIO TX
78204
US

V. Phone/Fax

Practice location:
  • Phone: 281-376-2652
  • Fax: 832-717-7483
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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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