Organization
GIANT OF MARYLAND LLC
Active
Other names
GIANT PHARMACY 352
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8782
Entity
Organization
Contact information
Practice address
3602 MILFORD MILL RD, BALTIMORE, MD 21244-3328
(410) 922-2400
(410) 922-2724
Mailing address
3602 MILFORD MILL RD, BALTIMORE, MD 21244-3328
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PO0257
MD
333600000X
Pharmacy
PO0257
MD
3336C0003X
Community/Retail Pharmacy
Primary
PO0257
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2101424
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
692304600
—
MD
Enumeration date
07/09/2006
Last updated
10/28/2011
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