Organization
H-E-B, LP
Active
Other names
HEB Pharmacy #612
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID LIENDO (GOVERNMENT PROGRAMS MANAGER)
(210) 938-3182
Entity
Organization
Contact information
Practice address
14414 US HIGHWAY 87 WEST, LAVERNIA, TX 78121
(830) 779-3109
(830) 779-4190
Mailing address
646 SOUTH FLORES, SOUTH 1/PHARMACY, SAN ANTONIO, TX 78204
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
—
—
3336C0003X
Community/Retail Pharmacy
Primary
26863
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26863
TEXAS STATE BOARD OF PHARMACY
TX
01
—
4555415
NCPDP
TX
05
—
469494
—
TX
Enumeration date
04/22/2010
Last updated
09/23/2020
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