Organization
HARRIS TEETER LLC
Active
Other names
Harris Teeter Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA WARMAN (MANAGER RX LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
6610 OLD MONROE RD., INDIAN TRAIL, NC 28079
(704) 289-1193
(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
09041
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0905555
—
NC
01
—
3403540
NABP
—
01
—
7704395
MEDICAID DME
—
Enumeration date
09/07/2006
Last updated
03/07/2023
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