NPIMap

Organization Active NPI

Harris Teeter, LLC

  • Community/Retail Pharmacy
  • Fulton, MD
National Provider Identifier
1679806517
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PO5068 Issued in MD
Legal business name
HARRIS TEETER, LLC
Practice address
8184 Westside Blvd
Fulton, MD 20759-2587
Phone
(301) 362-5761
Fax
(301) 362-5273
NPI assigned
Sep 10, 2009
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 W Ward
Title
Manager, Pharmacy Accountig
Phone
(704) 844-6524

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PO5068 MD Primary

Addresses

Primary practice location

8184 Westside Blvd
Fulton, MD 20759-2587

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
026017700MedicaidMD
21-34877OtherNCPDP

Other names 1

  • Harris Teeter Pharmacy Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930009697 MD DME Supplier - Pharmacy 9234255217 Practice locations: Fulton, MD
O20101112000471 MD Part B Supplier - Pharmacy 9234255217 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fulton, MD; Easton, MD; Baltimore, MD; Columbia, MD

Other NPIs on the same Medicare enrollment 5

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

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
21D2155502Harris Teeter Pharmacy #97-03238184 Westside Drive, Fulton, MD 20759Certificate of waiverSep 30, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Harris Teeter Pharmacy #3238184 Westside Blvd, Fulton, MD 20759-2587(301) 362-5761 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 14

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

View all 14

Member of 1

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

Locations

8184 Westside Blvd
Fulton, MD 20759
Phone (301) 362-5761

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1252540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1679806517",
    "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": "8184 WESTSIDE BLVD",
            "city": "FULTON",
            "state": "MD",
            "postal_code": "207592587",
            "telephone_number": "301-362-5761",
            "fax_number": "301-362-5273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRIS TEETER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-10",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "ROSE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MANAGER, PHARMACY ACCOUNTIG",
        "authorized_official_telephone_number": "704-844-6524"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MD",
            "license": "PO5068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026017700",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "21-34877",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harris Teeter Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fulton, MD

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.