NPIMap

Organization Active NPI

Harris Teeter, LLC

  • Community/Retail Pharmacy
  • Baltimore, MD
National Provider Identifier
1760805931
Registry record updated Sep 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
HARRIS TEETER, LLC
Practice address
3779 Boston Street
Baltimore, MD 21224
Phone
(704) 844-3418
NPI assigned
Jan 24, 2014
Last updated
Sep 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2016

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 1

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

Addresses

Primary practice location

3779 Boston Street
Baltimore, MD 21224

Mailing address

PO Box 842772
Boston, MA 02284
Phone (513) 762-1019

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140529001800 MD Part B Supplier - Mass Immunization (Roster Biller Only) 9234255217 5 other NPIs on this enrollment
Practice locations: Dunkirk, MD; Severna Park, MD; Ellicott City, MD; California, MD; Baltimore, MD
O20140602000036 MD DME Supplier - Pharmacy 9234255217 Practice locations: Baltimore, 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
21D2155485Harris Teeter Pharmacy #97-03923779 Boston Street, Baltimore, MD 21224Certificate of waiverSep 30, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Harris Teeter, LLC3779 Boston St, Baltimore, MD 21224-5752(410) 522-0804 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 13

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

View all 13

Member of 1

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

Locations

3779 Boston St
Baltimore, MD 21224
Phone (410) 522-0270

NPI Registry JSON

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

{
    "created_epoch": "1390521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474588800000",
    "number": "1760805931",
    "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": "02284",
            "telephone_number": "513-762-1019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3779 BOSTON STREET",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21224",
            "telephone_number": "704-844-3418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRIS TEETER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-24",
        "last_updated": "2016-09-23",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2016; 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.