Organization
GIANT OF MARYLAND LLC
Active
Other names
GIANT PHARMACY 250
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8782
Entity
Organization
Contact information
Practice address
635 POTOMAC STATION DR, LEESBURG, VA 20176-1818
(571) 258-1901
(571) 258-1909
Mailing address
635 POTOMAC STATION DR, LEESBURG, VA 20176-1818
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0201003967
VA
333600000X
Pharmacy
0201003967
VA
3336C0003X
Community/Retail Pharmacy
Primary
0201003967
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010068819
—
VA
01
—
4838059
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/11/2006
Last updated
01/06/2012
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