34D2100592 CLIA NUMBER - HARRIS TEETER #129

Laboratory Demographics

CLIA Number: 34D2100592

Facility Name: HARRIS TEETER #129

Facility Address:
6610 OLD MONROE ROAD ATTN PHARMACIST IN CHARGE
INDIAN TRAIL, NC
ZIP 28079
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Facility Phone Number: 704 289-1193

Facility Type: Other - RETAIL PHARMACY

Certificate Type: Waiver

NPI Number: 1659475085

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	34D2100592
LAB Type	Other - RETAIL PHARMACY
Facility Name	HARRIS TEETER #129
Street	6610 OLD MONROE ROAD ATTN PHARMACIST IN CHARGE
City	INDIAN TRAIL
State	NC
ZIP	28079
Phone	704 289-1193
CertificateType	4
CertificateEffectiveDate	8/18/2023
CertificateExpirationDate	8/17/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024