Organization
GIANT OF MARYLAND LLC
Active
Other names
GIANT PHARMACY 788
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8782
Entity
Organization
Contact information
Practice address
14125 SAINT GERMAIN DR, CENTREVILLE, VA 20121-2310
(703) 631-7720
(703) 263-1860
Mailing address
14125 SAINT GERMAIN DR, CENTREVILLE, VA 20121-2310
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0201003054
VA
333600000X
Pharmacy
0201003054
VA
3336C0003X
Community/Retail Pharmacy
Primary
0201003054
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008515913
—
VA
01
—
4820723
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/09/2006
Last updated
10/20/2011
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