MEDICARE: H-E-B, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1619741386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H-E-B, LP

Provider Business Mailing Address
First Line	:	646 S FLORES ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78204-1219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3451 HERITAGE TRACE PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-7505
Country	:	US
Telephone Number	:	817-232-8632
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR OF PHARMACY
Name	:	JAY BUECHE
Credential	:
Telephone Number	:	210-938-3182

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/06/2024

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