Provider Demographics
NPI:1194066936
Name:HEB # 451
Entity type:Organization
Organization Name:HEB # 451
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:512-336-7706
Mailing Address - Street 1:7301 N FM 620
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-4539
Mailing Address - Country:US
Mailing Address - Phone:512-336-7706
Mailing Address - Fax:512-336-7734
Practice Address - Street 1:7301 N FM 620
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-4539
Practice Address - Country:US
Practice Address - Phone:512-336-7706
Practice Address - Fax:512-336-7734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty