1144544883 NPI number — HARRIS TEETER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144544883 NPI number — HARRIS TEETER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARRIS TEETER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HARRIS TEETER PHARMACY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144544883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 CRESTDALE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MATTHEWS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28105-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-844-3100
Provider Business Mailing Address Fax Number:
704-844-6556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2195 TEA PLANTER LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT. PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-881-2622
Provider Business Practice Location Address Fax Number:
843-881-2852
Provider Enumeration Date:
03/24/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
ROSE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIR. PHARMACY ACCOUNTING
Authorized Official Telephone Number:
704-844-6524

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)