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	333600000X	Pharmacy
2	291U00000X	Clinical Medical Laboratory
3	3336C0003X	Community/Retail Pharmacy	21194	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4534524	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790894764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H-E-B, LP

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

Provider Business Practice Location Address
First Line	:	4821 BROADWAY ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209
Country	:	US
Telephone Number	:	210-824-0515
Fax Number	:	210-805-8951

Authorized Official
Title or Position	:	GOVERNMENT PROGRAMS MANAGER
Name	:	DAVID LIENDO
Credential	:
Telephone Number	:	210-938-3182

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/25/2020

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Directions to “H-E-B, LP ” Practice Location

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