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Organization

HARRIS TEETER, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ALLISON BREDESTEGE (MANAGER PHARMACY LICENSING)
(513) 762-1019
Entity
Organization

Contact information

Practice address
3333 PINEVILLE MATTHEWS RD, CHARLOTTE, NC 28226-9322
(704) 544-4815
(704) 544-4826
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
06492
NC
3336C0003X
Community/Retail Pharmacy
Primary
06492
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0608728
NC
01
3434292
NABP
01
7703251
MEDICAID DME
Enumeration date
08/22/2006
Last updated
03/07/2023
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