Organization
HARRIS TEETER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON BREDESTEGE (MANAGER PHARMACY LICESNING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
1811 MATTHEWS TOWNSHIP PKWY, MATTHEWS, NC 28105-4659
(704) 844-6822
(704) 846-2139
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
6110
NC
3336C0003X
Community/Retail Pharmacy
Primary
06110
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0608158
—
NC
01
—
3432325
NABP
—
01
—
7703108
MEDICAID DME
—
Enumeration date
09/08/2006
Last updated
03/07/2023
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