NPIMap

Organization Active NPI

Harris Teeter, LLC

  • Community/Retail Pharmacy
  • Fairfax, VA
National Provider Identifier
1598093627
Registry record updated Oct 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
HARRIS TEETER, LLC
Practice address
3905 Fair Ridge Dr
Fairfax, VA 22033-2906
Phone
(703) 877-0580
Fax
(703) 877-0592
NPI assigned
Dec 1, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2014

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

Authorized official

Name
Rose W Ward
Title
Dir Pharmacy Accounting
Phone
(704) 844-6524

Specialties & licenses 1

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

Addresses

Primary practice location

3905 Fair Ridge Dr
Fairfax, VA 22033-2906

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
4841981OtherVANCPDP

Other names 1

  • Harris Teeter Pharmacy Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110502000243 VA DME Supplier - PharmacyDME Supplier - Grocery Store 9234255217 Practice locations: Fairfax, 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 20

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

View all 20

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
49D2103169Harris Teeter Pharmacy #2533905 Fair Ridge Drive, Fairfax, VA 22033Certificate of waiverOct 5, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Harris Teeter LLC3905 Fair Ridge Dr, Fairfax, VA 22033-2906(703) 877-0580 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.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1259625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412812800000",
    "number": "1598093627",
    "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": "3905 FAIR RIDGE DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332906",
            "telephone_number": "703-877-0580",
            "fax_number": "703-877-0592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRIS TEETER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-01",
        "last_updated": "2014-10-09",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "ROSE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "DIR PHARMACY ACCOUNTING",
        "authorized_official_telephone_number": "704-844-6524"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4841981",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harris Teeter Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 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.