Healthcare Provider Details

I. General information

NPI: 1225856859
Provider Name (Legal Business Name): HARRIS TEETER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 TEACHEY PLACE
APEX NC
27523
US

IV. Provider business mailing address

PO BOX 830242
PHILADELPHIA PA
19182-0352
US

V. Phone/Fax

Practice location:
  • Phone: 704-844-4147
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: AMBER NICOLE WILLIAMS
Title or Position: LICENSING MANAGER
Credential:
Phone: 513-762-1090