Active NPI
Harris Teeter, LLC
- Community/Retail Pharmacy
- Charlotte, NC
National Provider Identifier
1609977115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 08434
- Legal business name
- HARRIS TEETER, LLC
- Practice address
- 2201 W.T. Harris Blvd.
Charlotte, NC 28269 - Phone
- (704) 295-0019
- Fax
- (704) 844-6556
- NPI assigned
- Sep 26, 2006
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 08434 | NC | |
| Community/Retail Pharmacy | 3336C0003X | 08434 | NC | Primary |
Addresses
Primary practice location
2201 W.T. Harris Blvd.
Charlotte, NC 28269
Mailing address
701 Crestdale Rd
Matthews, NC 28105-1700
Phone (704) 844-3100
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0609740 | Medicaid | NC | |
| 7703999 | Other | NC | MEDICAID DME |
| 3441689 | Other | NC | NABP |
Other names 1
- Harris Teeter Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100928000148 | NC | Part B Supplier - Mass Immunization (Roster Biller Only) | 9234255217 | This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider DirectoryMember 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": "1159228800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1678147200000",
"number": "1609977115",
"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": "2201 W.T. HARRIS BLVD.",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "28269",
"telephone_number": "704-295-0019",
"fax_number": "704-844-6556"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HARRIS TEETER, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-26",
"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": "08434",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NC",
"license": "08434",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0609740",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID DME",
"identifier": "7703999",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NABP",
"identifier": "3441689",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Harris Teeter Pharmacy",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Charlotte, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.