Organization
GIANT OF MARYLAND LLC
Active
Other names
GIANT PHARMACY 783
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8782
Entity
Organization
Contact information
Practice address
6011 BURKE CENTRE PKWY, BURKE, VA 22015-3717
(703) 425-0362
(703) 239-1560
Mailing address
6011 BURKE CENTRE PKWY, BURKE, VA 22015-3717
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0201003052
VA
333600000X
Pharmacy
0201003052
VA
3336C0003X
Community/Retail Pharmacy
Primary
0201003052
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008515921
—
VA
01
—
4820521
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/11/2006
Last updated
10/20/2011
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