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NPI Code Detail

MEDICARE: HARRIS TEETER PHARMACY #208

MEDICARE: HARRIS TEETER PHARMACY #208
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
13336C0003XCommunity/Retail Pharmacy12325SC
23336C0003XCommunity/Retail Pharmacy15937NC

General Provider Information

NPI Number : 1518259613
Entity Type Code : Organization
Provider Name (Legal Business Name) : HARRIS TEETER PHARMACY #208
Provider Business Mailing 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
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 : PHARMACY MANAGER
Name : DR. JONATHAN GADDY
Credential : PHARMD
Telephone Number : 704-366-5684
Provider Enumeration Date : 05/07/2011
Last Update Date : 05/07/2011

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