# HARRIS TEETER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Harris Teeter Pharmacy \#475
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588927057
- **Authorized official:** JESSIE WARMAN (MANAGER RX LICENSING)
- **Authorized official phone:** (513) 762-1090

## Contact information

- **Practice address:** 867 STOCKBRIDGE DR, FORT MILL, SC 29708-7233
- **Practice address phone:** (704) 844-6524
- **Practice address fax:** (704) 844-6556
- **Mailing address:** 701 CRESTDALE RD, MATTHEWS, NC 28105-1700
- **Mailing address phone:** (704) 844-6524
- **Mailing address fax:** (704) 844-6556

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 06/20/2012
- **Last updated:** 08/02/2019