NPIMap

Organization Active NPI

Harris Teeter,LLC

Doing business as Harris Teeter Pharmacy #369

  • Community/Retail Pharmacy
  • Virginia Beach, VA
National Provider Identifier
1851714026
Registry record updated Jul 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
HARRIS TEETER,LLC
Doing business as
Harris Teeter Pharmacy #369
Practice address
4540 Princess Anne Road
Virginia Beach, VA 23462
Phone
(704) 844-3418
NPI assigned
Jan 24, 2014
Last updated
Jul 31, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2015

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

4540 Princess Anne Road
Virginia Beach, VA 23462

Mailing address

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

Other names 1

  • Harris Teeter Pharmacy #369 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140217000368 VA Part B Supplier - Mass Immunization (Roster Biller Only) 9234255217 8 other NPIs on this enrollment
Practice locations: Williamsburg, VA; Virginia Beach, VA; Norfolk, VA; Gainsville, VA; Charlottesville, VA
O20140618001215 VA DME Supplier - PharmacyDME Supplier - Grocery Store 9234255217 Practice locations: Virginia Beach, VA

Other NPIs on the same Medicare enrollment 7

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
49D2101288Harris Teeter #3694540 Princess Anne Road #117, Virginia Beach, VA 23462Certificate of waiverAug 30, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Harris Teeter,LLC4540 Princess Anne Rd, Virginia Beach, VA 23462-7963(757) 467-4650 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 21

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

View all 21

Member 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": "1390521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438300800000",
    "number": "1851714026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 CRESTDALE ROAD",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "28105",
            "telephone_number": "704-844-3418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4540 PRINCESS ANNE ROAD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23462",
            "telephone_number": "704-844-3418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRIS TEETER,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-24",
        "last_updated": "2015-07-31",
        "status": "A",
        "authorized_official_last_name": "NOBLITT",
        "authorized_official_first_name": "MARY",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harris Teeter Pharmacy #369",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2015; 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.