H-E-B, LP

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

H-E-B, LP

Practice address

97 Oyster Creek Drive
Lake Jackson, TX 77566

Phone

(979) 299-0105

Fax

(979) 266-5183

NPI assigned

Nov 24, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Liendo

Title

Government Programs Manager

Phone

(210) 938-3182

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• HEB Pharmacy #707 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brian Diaz

  • Pharmacy Technician
  • Lake Jackson, TX
  • NPI 1720903024
  NPD (past)
• Raquel Enriquez

  • Pharmacy Technician
  • Lake Jackson, TX
  • NPI 1487234340
  NPD (past)
• Corina Rae Fitze-Vallier, PHARMACY TECHNICIAN

  • Pharmacy Technician
  • Lake Jackson, TX
  • NPI 1740909407
  NPD (past)
• Selena Guerrero

  • Pharmacy Technician
  • Lake Jackson, TX
  • NPI 1790365641
  NPD (past)
• Ray Kabayadondo, PHARMD

  • Pharmacist
  • Lake Jackson, TX
  • NPI 1629578141
  NPD (past)
• Raquel Victoria Lujan

  • Pharmacy Technician
  • Lake Jackson, TX
  • NPI 1750081071
  NPD (past)
• Kaitlyn Adelle Matejowsky

  • Pharmacy Technician
  • Lake Jackson, TX
  • NPI 1851062343
  NPD (past)
• Suzanne Olivares

  • Pharmacy Technician
  • Lake Jackson, TX
  • NPI 1174112544
  NPD (past)
• Jacob Ottis Pate

  • Pharmacy Technician
  • Lake Jackson, TX
  • NPI 1821765066
  NPD (past)
• Melissa Rodriguez

  • Pharmacy Technician
  • Lake Jackson, TX
  • NPI 1871260604
  NPD (past)
• Ashley Nicole Mae Simms

  • Pharmacy Technician
  • Lake Jackson, TX
  • NPI 1457940710
  NPD (past)
• Justin Lynn Vardeman

  • Pharmacy Technician
  • Lake Jackson, TX
  • NPI 1366031395
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600905600000",
    "number": "1306243035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "646 SOUTH FLORES",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782041210",
            "telephone_number": "210-938-3182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 OYSTER CREEK DRIVE",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "77566",
            "telephone_number": "979-299-0105",
            "fax_number": "979-266-5183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "H-E-B, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-24",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A",
        "authorized_official_last_name": "LIENDO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "GOVERNMENT PROGRAMS MANAGER",
        "authorized_official_telephone_number": "210-938-3182"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "469129",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS STATE BOARD OF PHARMACY",
            "identifier": "29683",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "5914557",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HEB Pharmacy #707",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HEB Pharmacy #707",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Lake Jackson, TX
• Providers in Lake Jackson, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.