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Provider Information for 1770685158


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HARRIS TEETER, LLC

Other Names:  
Other Name: 
HARRIS TEETER PHARMACY

Organization Subpart: NO

NPI: 1770685158
Last Updated: 2023-03-07
Certification Date:

Details

NameValue
NPI1770685158
Enumeration Date2006-09-05
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: ROSE WARD
Title: Manager, Pharmacy Admin/AR
Phone: 7048446524
Mailing Address 701 CRESTDALE RD
MATTHEWS, NC 28105-1700
United States

Phone: 704-844-3100 | Fax:704-844-6556
 
Primary Practice Address 5277 SUNSET LAKE RD
HOLLY SPRINGS, NC 27540-3768
United States

Phone: 919-363-4729 | Fax:704-844-6556
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDNC0920829
Other (non-Medicare)3404213NABP
Other (non-Medicare)7704352Medicaid DME
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies NC09057
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyNC09057