MEDICARE: HARRIS TEETER, LLC

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
1	332B00000X	Durable Medical Equipment & Medical Supplies	09892	NC
2	3336C0003X	Community/Retail Pharmacy	09892	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3408920	OTHER	NABP

General Provider Information

NPI Number	:	1518157064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRIS TEETER, LLC

Provider Business Mailing Address
First Line	:	701 CRESTDALE RD
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-1700
Country	:	US
Telephone Number	:	704-844-3100
Fax Number	:	704-844-6556

Provider Business Practice Location Address
First Line	:	5920 CAROLINA BEACH RD.
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412
Country	:	US
Telephone Number	:	910-796-3283
Fax Number	:	704-844-6556

Authorized Official
Title or Position	:	MANAGER, PHARMACY ADMIN/AR
Name	:	ROSE WARD
Credential	:
Telephone Number	:	704-844-6524

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	03/07/2023

Similar Medicare Providers

1912864620 — HAYDEN THOMAS PMHNP
Practice Location Address:

2601 IRON GATE DR STE 204
WILMINGTON, NC
28412-6624

Practice Phone: 910-500-7072
Practice Fax:

1730785791 — JOHN LAZZARI
Practice Location Address:

2716 ASHTON DR
WILMINGTON, NC
28412-2489

Practice Phone: 910-332-3800
Practice Fax: 910-251-0421

1447254438 — ELIZABETH A DEATON PNP
Practice Location Address:

615 SHIPYARD BLVD
WILMINGTON, NC
28412-6431

Practice Phone: 910-343-0145
Practice Fax: 910-341-5779

1932103439 — DR. JAMIE J CASPER O.D., PHD, FAAO
Practice Location Address:

5526 CAROLINA BEACH RD , SUITE B
WILMINGTON, NC
28412-2606

Practice Phone: 910-452-7225
Practice Fax: 910-452-7229

1063413243 — ALBERT W MARR MD
Practice Location Address:

2716 ASHTON DR
WILMINGTON, NC
28412-2489

Practice Phone: 910-332-3800
Practice Fax: 910-251-0421

1336141258 — RICHARD S. MOORE JR. MD
Practice Location Address:

2716 ASHTON DR
WILMINGTON, NC
28412-2489

Practice Phone: 910-763-7344
Practice Fax: 910-251-0421

1982606638 — DANIEL ANDREW CULBRETH PA
Practice Location Address:

2716 ASHTON DR
WILMINGTON, NC
28412-2489

Practice Phone: 910-332-3800
Practice Fax: 910-763-8804

Directions to “HARRIS TEETER, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.