Organization
HARRIS TEETER LLC
Active
Other names
HARRIS TEETER PHARMACY #350
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON BREDESTEGE (PHARMACY LICENSING MANAGER)
(513) 762-1019
Entity
Organization
Contact information
Practice address
5060 FERRELL PARKWAY, VIRGINIA BEACH, VA 23464
(757) 467-2058
(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
201004214
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619154341
—
VA
01
—
4840713
NABP
—
01
—
7704889
MEDICAID DME
—
Enumeration date
01/24/2008
Last updated
03/07/2023
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