Organization
GIANT OF MARYLAND LLC
Active
Other names
GIANT PHARMACY 228
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8732
Entity
Organization
Contact information
Practice address
11200 MAIN STREET, FAIRFAX, VA 22030
(703) 277-2864
(703) 277-3190
Mailing address
11200 MAIN STREET, FAIRFAX, VA 22030
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0201003255
VA
333600000X
Pharmacy
0201003255
VA
3336C0003X
Community/Retail Pharmacy
Primary
0201003255
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008506485
—
VA
01
—
4828945
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/09/2006
Last updated
09/23/2011
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