Organization
GIANT OF MARYLAND LLC
Active
Other names
Giant Pharmacy #791
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8982
Entity
Organization
Contact information
Practice address
43760 GREENWAY CORPOATE DRIVE, ASHBURN, VA 20147
(401) 238-3820
(401) 238-3057
Mailing address
1385 HANCOCK ST, QUINCY, MA 02169-5103
(401) 238-3820
(401) 238-3057
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
201004105
VA
3336C0003X
Community/Retail Pharmacy
Primary
0201004105
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010324092
—
VA
01
—
4839467
NCPDP
VA
Enumeration date
10/11/2006
Last updated
10/20/2011
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