Organization
GIANT OF MARYLAND LLC
Active
Other names
GIANT PHARMACY 237
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8782
Entity
Organization
Contact information
Practice address
25050 RIDING PLZ STE 100, CHANTILLY, VA 20152-5910
(703) 542-2990
(703) 542-2953
Mailing address
25050 RIDING PLZ STE 100, CHANTILLY, VA 20152-5910
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
201004007
VA
333600000X
Pharmacy
201004007
VA
3336C0003X
Community/Retail Pharmacy
Primary
201004007
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010128862
—
VA
01
—
4838427
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/09/2006
Last updated
10/28/2011
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