Organization
GIANT OF MARYLAND LLC
Active
Other names
GIANT PHARMACY 363
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8782
Entity
Organization
Contact information
Practice address
1400 MERRITT BLVD, DUNDALK, MD 21222-2110
(410) 631-1280
(410) 631-1288
Mailing address
1400 MERRITT BLVD, DUNDALK, MD 21222-2110
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PO2617
MD
333600000X
Pharmacy
PO2617
MD
3336C0003X
Community/Retail Pharmacy
Primary
PO2617
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2125967
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
699615900
—
MD
Enumeration date
07/09/2006
Last updated
11/17/2011
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