Organization
GIANT OF MARYLAND LLC
Active
Other names
SUPER G PHARMACY 387
Organization subpart
No
Provider details
NPI number
Authorized official
IRA KRESS (PRESIDENT)
(207) 885-7454
Entity
Organization
Contact information
Practice address
19312 LIGHTHOUSE PLAZA BLVD, REHOBOTH BEACH, DE 19971
(302) 227-5954
(302) 226-6190
Mailing address
PO BOX 1000, MS 3000, PORTLAND, ME 04104-5005
(207) 885-7454
(704) 645-6531
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
A30000654
DE
333600000X
Pharmacy
A30000654
DE
3336C0003X
Community/Retail Pharmacy
Primary
A30000654
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000923207
—
DE
01
—
0803634
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/09/2006
Last updated
03/06/2020
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