NPIMap

Organization Active NPI

Harris Teeter LLC

  • Community/Retail Pharmacy
  • Laurel, MD
National Provider Identifier
1801205505
Registry record updated Aug 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
HARRIS TEETER LLC
Practice address
14702 Baltimore Ave
Laurel, MD 20707-4816
Phone
(704) 844-3418
NPI assigned
Aug 6, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2014

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

Authorized official

Name
Mary K Noblitt
Title
License Administrator
Phone
(704) 844-3418

Specialties & licenses 1

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

Addresses

Primary practice location

14702 Baltimore Ave
Laurel, MD 20707-4816

Mailing address

701 Crestdale Rd
Matthews, NC 28105-1700
Phone (704) 844-3418

Other names 1

  • Harris Teeter Pharmacy #408 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
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…
O20140529001800 MD Part B Supplier - Mass Immunization (Roster Biller Only) 9234255217 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dunkirk, MD; Severna Park, MD; Ellicott City, MD; California, MD; Baltimore, MD
O20150109000248 MD DME Supplier - Pharmacy 9234255217 Practice locations: Laurel, MD

Other NPIs on the same Medicare enrollment 25

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

View all 25

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
21D2155474Harris Teeter Pharmacy #97-040814702 Baltimore Avenue, Laurel, MD 20707Certificate of waiverSep 30, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Harris Teeter Pharmacy #40814702 Baltimore Ave, Laurel, MD 20707-4816(301) 490-5497 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|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Suppli… Accepts assignmentParticipating since Mar 22, 2011

National Provider Directory

National Provider Directory

Member of 1

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

Locations

14702 Baltimore Ave
Laurel, MD 20707
Phone (301) 490-5487

NPI Registry JSON

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

{
    "created_epoch": "1407283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407283200000",
    "number": "1801205505",
    "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": "704-844-3418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14702 BALTIMORE AVE",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207074816",
            "telephone_number": "704-844-3418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRIS TEETER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-06",
        "last_updated": "2014-08-06",
        "status": "A",
        "authorized_official_last_name": "NOBLITT",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "LICENSE ADMINISTRATOR",
        "authorized_official_telephone_number": "704-844-3418"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harris Teeter Pharmacy #408",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.