Organization
HARRIS TEETER, LLC
Active
Other names
Harris Teeter Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA ANDREWS (MANAGER OF LICENSING)
(513) 762-1090
Entity
Organization
Contact information
Practice address
13639 PROVIDENCE RD, MATTHEWS, NC 28104-9373
(704) 847-5771
(704) 844-6556
Mailing address
701 CRESTDALE RD, MATTHEWS, NC 28105-1700
(704) 844-3100
(704) 844-6556
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
09287
NC
3336C0003X
Community/Retail Pharmacy
Primary
09287
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0905588
—
NC
01
—
3405708
NABP
NC
01
—
7704490
MEDICAID DME
NC
Enumeration date
10/03/2006
Last updated
12/13/2021
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