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General NPI Number Information
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NPI Number | 1841078409
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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 | 09/15/2023
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 1269 NEXTON PARKWAY
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City | SUMMERVILLE
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State | SC
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Zip | 29486
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Country | US
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Telephone | 843-974-9474
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Fax | 843-974-9464
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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 |
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Fax |
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Authorized Official
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Title or Position | MANAGER OF LICENSING
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Name | LYSETTE SEILHAMER
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Credential |
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Telephone | 515-762-1090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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