Healthcare Provider Details

I. General information

NPI: 1083877591
Provider Name (Legal Business Name): HARRIS TEETER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 WEST NC 54 HWY
DURHAM NC
27707
US

IV. Provider business mailing address

701 CRESTDALE RD
MATTHEWS NC
28105-1700
US

V. Phone/Fax

Practice location:
  • Phone: 919-403-8053
  • Fax: 704-844-6556
Mailing address:
  • Phone: 704-844-3100
  • Fax: 704-844-6556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number10118
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10118
License Number StateNC

VIII. Authorized Official

Name: LYSETTE SEILHAMER
Title or Position: MANAGER PHARMACY LICENSING
Credential:
Phone: 513-587-5328