NPIMap

Organization Active NPI

Harris Teeter, LLC

  • Community/Retail Pharmacy
  • Greensboro, NC
National Provider Identifier
1225108459
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
09404 Issued in NC
Legal business name
HARRIS TEETER, LLC
Practice address
3330 W Friendly Ave
Greensboro, NC 27410-4806
Phone
(336) 297-1467
Fax
(704) 844-6556
NPI assigned
Nov 8, 2006
Last updated
Mar 7, 2023By the provider in NPPES
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
Rose Ward
Title
Manager, Pharmacy Admin/Ar
Phone
(704) 844-6524

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 09404 NC
Community/Retail Pharmacy 3336C0003X 09404 NC Primary

Addresses

Primary practice location

3330 W Friendly Ave
Greensboro, NC 27410-4806

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
3407245OtherNABP
0418381MedicaidNC

Other names 1

  • Harris Teeter Pharmacy Other name

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
O20100930022483 NC DME Supplier - PharmacyDME Supplier - Grocery Store 9234255217 Practice locations: Greensboro, 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
34D2100733Harris Teeter #3063330W Friendly Ave, Greensboro, NC 27410Certificate of waiverAug 20, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Harris Teeter #3063330W Friendly Ave, Greensboro, NC 27410-4806(336) 297-1497 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.

Locations

3330 W Friendly Ave
Greensboro, NC 27410
Phone (336) 297-1467

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1225108459",
    "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": "3330 W FRIENDLY AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274104806",
            "telephone_number": "336-297-1467",
            "fax_number": "704-844-6556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRIS TEETER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "ROSE",
        "authorized_official_title_or_position": "MANAGER, PHARMACY ADMIN/AR",
        "authorized_official_telephone_number": "704-844-6524"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NC",
            "license": "09404",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "09404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "3407245",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0418381",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harris Teeter Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greensboro, NC

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.