Harris Teeter, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

08188 Issued in NC

Legal business name

HARRIS TEETER, LLC

Practice address

11516 Providence Rd.
Charlotte, NC 28277

Phone

(704) 841-4019

Fax

(704) 844-6556

NPI assigned

Sep 5, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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

Addresses

Other identifiers 3

Other names 1

• Harris Teeter Pharmacy Other name

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Member of 1

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

• The Kroger Co

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Macon, GA
  • NPI 1639194319

  Member Of

  NPD member

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1487756870",
    "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": "11516 PROVIDENCE RD.",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28277",
            "telephone_number": "704-841-4019",
            "fax_number": "704-844-6556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRIS TEETER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "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": "08188",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "08188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0609616",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "3440459",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "7703808",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harris Teeter Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Harris Teeter, LLC
• Harris Teeter, LLC
• Harris Teeter, LLC
• Harris Teeter, LLC
• Harris Teeter, LLC
• Harris Teeter, LLC
• Harris Teeter, LLC
• Harris Teeter, LLC
• Harris Teeter, LLC
• Harris Teeter, LLC

• Community/Retail Pharmacy in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Community/Retail Pharmacy in North Carolina

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.