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NPI Code Detail

MEDICARE: HARRIS TEETER, LLC

MEDICARE: HARRIS TEETER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies09376NC
23336C0003XCommunity/Retail Pharmacy09376NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23406813OTHERNABP
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366553737
Entity Type Code : Organization
Provider Name (Legal Business Name) : HARRIS TEETER, LLC
Provider Business Mailing Address
First Line : 701 CRESTDALE RD
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-1700
Country : US
Telephone Number : 704-844-3100
Fax Number : 704-844-6556
Provider Business Practice Location Address
First Line : 112 S SHARON AMITY RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28211-2802
Country : US
Telephone Number : 704-366-5684
Fax Number : 704-366-1598
Authorized Official
Title or Position : MANAGER PHARMACY ACCT/AR
Name : ROSE WARD
Credential :
Telephone Number : 704-844-6524
Provider Enumeration Date : 08/31/2006
Last Update Date : 03/07/2023

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Practice Location Address:
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Practice Fax: 704-366-1598
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Practice Fax:
1346692209 — ALICIA TYSON PHARMD
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CHARLOTTE, NC
28211-2802
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Practice Fax:
1497108625 — DR. JONATHAN GADDY PHARMD
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