Organization
GIANT OF MARYLAND LLC
Active
Other names
Giant #343
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8782
Entity
Organization
Contact information
Practice address
11740 ROUSBY HALL RD, LUSBY, MD 20657-2606
(410) 394-2170
(410) 394-2172
Mailing address
11740 ROUSBY HALL RD, LUSBY, MD 20657-2606
(410) 394-2170
(410) 394-2172
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
P04686
MD
3336C0003X
Community/Retail Pharmacy
Primary
P04686
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0161161 00
—
MD
01
—
2133786
NCPDP
MD
Enumeration date
12/13/2007
Last updated
10/13/2011
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