Organization Active NPI

Harris Teeter LLC

Doing business as Harris Teeter Pharmacy #430

  • Community/Retail Pharmacy
  • Cary, NC
National Provider Identifier
1104235803
Registry record updated Aug 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
HARRIS TEETER LLC
Doing business as
Harris Teeter Pharmacy #430
Practice address
885 Walnut St
Cary, NC 27511-4227
Phone
(704) 844-3418
NPI assigned
Aug 6, 2014
Last updated
Aug 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2014

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

Authorized official

Name
Mary K Noblitt
Title
License Administrator
Phone
(704) 844-3418

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

885 Walnut St
Cary, NC 27511-4227

Mailing address

701 Crestdale Rd
Matthews, NC 28105-1700
Phone (704) 844-3418

Other names 1

  • Harris Teeter Pharmacy #430 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100928000148 NC Part B Supplier - Mass Immunization (Roster Biller Only) 9234255217 This NPI is an additional NPI on the enrollment
O20141216000639 NC DME Supplier - Pharmacy 9234255217 Practice locations: Cary, NC

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2155136Harris Teeter Pharmacy #97-0430885 Walnut Street, Cary, NC 27511Certificate of waiverSep 24, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Harris Teeter LLC885 Walnut St, Cary, NC 27511-4227(919) 463-9265 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Nebulizer Equipment a… Accepts assignmentParticipating since Mar 22, 2011

National Provider Directory

National Provider Directory
Tax ID family
Harris Teeter LLC208 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1407283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407283200000",
    "number": "1104235803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 CRESTDALE RD",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281051700",
            "telephone_number": "704-844-3418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "885 WALNUT ST",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275114227",
            "telephone_number": "704-844-3418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRIS TEETER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-06",
        "last_updated": "2014-08-06",
        "status": "A",
        "authorized_official_last_name": "NOBLITT",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "LICENSE ADMINISTRATOR",
        "authorized_official_telephone_number": "704-844-3418"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harris Teeter Pharmacy #430",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cary, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2014; 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.