NPIMap

Organization Active NPI

Harris Teeter LLC

  • Community/Retail Pharmacy
  • Arlington, VA
National Provider Identifier
1194922930
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
0201004167 Issued in VA
Legal business name
HARRIS TEETER LLC
Practice address
3600 South Glebe Rd
Arlington, VA 22202
Phone
(703) 412-9144
Fax
(704) 844-6556
NPI assigned
Jun 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Allison Bredestege
Title
Pharmacy Licensing Manager
Phone
(513) 762-1019

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 0201004167 VA Primary

Addresses

Primary practice location

3600 South Glebe Rd
Arlington, VA 22202

Mailing address

701 Crestdale Rd
Matthews, NC 28105-1700
Phone (704) 844-3100

Other identifiers 2

IdentifierTypeStateIssuer
1194922930MedicaidVA
4840193OtherNABP

Other names 1

  • Harris Teeter Pharmacy Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20101104000770 DC Part B Supplier - Pharmacy 9234255217 18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Germantown, MD; Washington, DC; Potomac, MD; Olney, MD; Bowie, MD; Bethesda, MD
O20101229000190 VA Part B Supplier - Pharmacy 9234255217 40 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portsmouth, VA; Purcellville, VA; Sterling, VA; Chesapeake, VA; Suffolk, VA; Virginia Beach, VA; Warrenton, VA; Williamsburg, VA…
O20140529001652 DC Part B Supplier - Mass Immunization (Roster Biller Only) 9234255217 20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fairfax, VA; Arlington, VA; Falls Church, VA; Gaithersburg, MD; Herndon, VA; Laurel, MD; MC Lean, VA; Reston, VA…

Other NPIs on the same Medicare enrollment 57

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 57

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
49D2156435Harris Teeter Pharmacy #97-02623600 S Glebe Rd Suite W100, Arlington, VA 22202Certificate of waiverOct 17, 2026

National Provider Directory

National Provider Directory

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": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1194922930",
    "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": "704-844-3100",
            "fax_number": "704-844-6556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 SOUTH GLEBE RD",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "22202",
            "telephone_number": "703-412-9144",
            "fax_number": "704-844-6556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRIS TEETER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "BREDESTEGE",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "PHARMACY LICENSING MANAGER",
        "authorized_official_telephone_number": "513-762-1019"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VA",
            "license": "0201004167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194922930",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "4840193",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harris Teeter Pharmacy",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Harris Teeter Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Arlington, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.