Organization
GIANT OF MARYLAND LLC
Active
Other names
Giant Pharmacy #790
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT STONE (DIRECTOR THIRD PARTY)
(617) 770-6257
Entity
Organization
Contact information
Practice address
5581 MERCHANTS VIEW SQUARE, HAYMARKET, VA 20169
(571) 248-4551
(571) 248-4555
Mailing address
185 CAMPANELLI DR, BRAINTREE, MA 02184
(781) 380-5611
(781) 380-5617
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0201004106
VA
3336C0003X
Community/Retail Pharmacy
Primary
0201004106
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010328471
—
VA
01
—
4839467
NCPDP
VA
Enumeration date
08/29/2006
Last updated
02/06/2009
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