Harris Teeter LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

HARRIS TEETER LLC

Doing business as

Harris Teeter #34

Practice address

4800 First Coast Hwy
Fernandina Beach, FL 32034-5597

Phone

(704) 844-4147

NPI assigned

Jun 22, 2017

Last updated

Jan 9, 2018By 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

Allison Bredestege

Title

Pharmacy Licensing Manager

Phone

(513) 762-1019

Specialties & licenses 2

Addresses

Other names 1

• HARRIS TEETER #34 Doing business as

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Tax ID family

Harris Teeter LLC208 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 1

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Harris Teeter, Inc.

  • Community/Retail Pharmacy
  • Ponte Vedra Beach, FL
  • NPI 1336241405
  NPD tax ID

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
  • Pickerington, OH
  • NPI 1245255967

  Member Of

  NPD member

Practitioners 1

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.

• Heather Neighbors

  • Pharmacist
  • Fernandina Beach, FL
  • NPI 1689794810
  NPD (past)

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

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515456000000",
    "number": "1619497583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 842772",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022842772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 FIRST COAST HWY",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320345597",
            "telephone_number": "704-844-4147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRIS TEETER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-22",
        "last_updated": "2018-01-09",
        "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": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HARRIS TEETER #34",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HARRIS TEETER #34",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• William Edward Hansberry, MD
• Patrick James Hanson
• Helen Orieanna Harding, R,CT,MR
• Jennifer Harper, ARNP
• Elizabeth Anne Harrelson-Lee, DC
• Kimberly Brooke Harris, OTR/L
• Megan Harris, PA-C
• Ruth Phillips Harrison, MS OTR/L
• Nancy Hart, PA
• Lester N Hauge, M.D.

• Community/Retail Pharmacy in Fernandina Beach, FL
• Providers in Fernandina Beach, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2018; 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.