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General NPI Number Information
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NPI Number | 1760576243
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Entity Type | Organization
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Legal Business Name | HARRIS TEETER, LLC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 20070 ASHBROOK COMMONS PLZ
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City | ASHBURN
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State | VA
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Zip | 20147-5034
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Country | US
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Telephone | 571-233-0517
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Fax | 571-223-0542
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Provider Business Mailing Address
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Address Line | PO BOX 842772
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City | BOSTON
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State | MA
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Zip | 02284-2772
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Country | US
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Telephone | 513-762-1019
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Fax |
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Authorized Official
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Title or Position | MANAGER PHARMACY LICENSING
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Name | ALLISON BREDESTEGE
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Credential |
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Telephone | 513-762-1019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0201004030
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License Number State | VA
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