Provider Demographics
NPI:1144572850
Name:HARRIS TEETER LLC
Entity Type:Organization
Organization Name:HARRIS TEETER LLC
Other - Org Name:HARRIS TEETER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANGER OF PHARMACY LICENSING
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:MUENNICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-762-1019
Mailing Address - Street 1:PO BOX 842772
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284
Mailing Address - Country:US
Mailing Address - Phone:513-762-1263
Mailing Address - Fax:
Practice Address - Street 1:975 SAVANNAH HWY
Practice Address - Street 2:SUITE 135
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7859
Practice Address - Country:US
Practice Address - Phone:843-556-5630
Practice Address - Fax:843-556-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1226450155Medicare NSC