Organization
HARRIS TEETER LLC
Active
Other names
HARRIS TEETER PHARMACY #83
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE WARMAN (MANAGER RX LICENSING)
(513) 762-1090
Entity
Organization
Contact information
Practice address
900 ARMY NAVY DR., ARLINGTON, VA 22202
(703) 413-1664
(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
3336C0003X
Community/Retail Pharmacy
Primary
0201003740
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10065691
MEDICAID DME
—
01
—
4836120
NABP
—
05
—
8507813
—
VA
Enumeration date
09/01/2006
Last updated
03/07/2023
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