Organization
GIANT OF MARYLAND LLC
Active
Other names
GIANT PHARMACY 794
Organization subpart
No
Provider details
NPI number
Authorized official
BOB STONE (DIR 3RD PARTY AND MANAGED CARE)
(617) 770-6257
Entity
Organization
Contact information
Practice address
21000 SOUTHBANK ST STE 150, STERLING, VA 20165-7242
(703) 430-0400
(703) 421-1190
Mailing address
21000 SOUTHBANK ST STE 150, STERLING, VA 20165-7242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0201003211
VA
333600000X
Pharmacy
0201003211
VA
3336C0003X
Community/Retail Pharmacy
Primary
0201003211
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008504954
—
VA
01
—
4828426
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/09/2006
Last updated
05/28/2009
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