Provider Demographics
NPI:1578826962
Name:HARRIS TEETER INC.
Entity Type:Organization
Organization Name:HARRIS TEETER INC.
Other - Org Name:HARRIS TEETER PHARMACY #472
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR. PHARMACY ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:W
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-844-6524
Mailing Address - Street 1:701 CRESTDALE RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1700
Mailing Address - Country:US
Mailing Address - Phone:704-844-6524
Mailing Address - Fax:
Practice Address - Street 1:8445 DAVIS LAKE PKWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3414
Practice Address - Country:US
Practice Address - Phone:704-844-3100
Practice Address - Fax:704-844-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11279332B00000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies