Organization
GIANT OF MARYLAND LLC
Active
Other names
GIANT PHARMACY 768
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8782
Entity
Organization
Contact information
Practice address
8819 CENTREVILLE RD, MANASSAS, VA 20110-5203
(703) 361-5521
(703) 335-9851
Mailing address
8819 CENTREVILLE RD, MANASSAS, VA 20110-5203
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
0201003045
VA
3336C0003X
Community/Retail Pharmacy
Primary
0201003045
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008513210
—
VA
01
—
4816964
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/09/2006
Last updated
10/28/2011
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