NPIMap

Organization Active NPI

Harris Teeter, LLC

  • Community/Retail Pharmacy
  • Herndon, VA
National Provider Identifier
1932308202
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
0201004187 Issued in VA
Legal business name
HARRIS TEETER, LLC
Practice address
2311 Woodland Crossing Dr.
Herndon, VA 20171
Phone
(703) 796-0239
Fax
(704) 844-6556
NPI assigned
Jul 16, 2007
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 Ward
Title
Manager, Pharmacy Admin
Phone
(704) 844-6524

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 0201004187 VA Primary

Addresses

Primary practice location

2311 Woodland Crossing Dr.
Herndon, VA 20171

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
1932308202MedicaidVA
4840294OtherNABP

Other names 1

  • Harris Teeter Pharmacy Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20100930062144 VA DME Supplier - PharmacyDME Supplier - Grocery Store 9234255217 Practice locations: Herndon, VA
O20101104000770 DC Part B Supplier - Pharmacy 9234255217 18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Germantown, MD; Washington, DC; Potomac, MD; Olney, MD; Bowie, MD; Bethesda, MD
O20101229000190 VA Part B Supplier - Pharmacy 9234255217 40 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portsmouth, VA; Purcellville, VA; Sterling, VA; Chesapeake, VA; Suffolk, VA; Virginia Beach, VA; Warrenton, VA; Williamsburg, VA…
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…

Other NPIs on the same Medicare enrollment 57

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

View all 57

National Provider Directory

National Provider Directory

Member of 1

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

Locations

2311 Woodland Xing Dr
Herndon, VA 20171
Phone (703) 796-0239

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1932308202",
    "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": "2311 WOODLAND CROSSING DR.",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "20171",
            "telephone_number": "703-796-0239",
            "fax_number": "704-844-6556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRIS TEETER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-16",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "ROSE",
        "authorized_official_title_or_position": "MANAGER, PHARMACY ADMIN",
        "authorized_official_telephone_number": "704-844-6524"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VA",
            "license": "0201004187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932308202",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "4840294",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harris Teeter Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Herndon, VA

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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.