Organization
GIANT OF MARYLAND LLC
Active
Organization
GIANT OF MARYLAND LLC
Active
Other names
GIANT PHARMACY 741
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8782
Entity
Organization
Contact information
Practice address
5469 MAPLEDALE PLZ, DALE CITY, VA 22193-4526
(703) 590-1700
(703) 590-6840
Mailing address
5469 MAPLEDALE PLZ, DALE CITY, VA 22193-4526
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0201003059
VA
333600000X
Pharmacy
0201003059
VA
3336C0003X
Community/Retail Pharmacy
Primary
0201003059
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008530173
—
VA
01
—
4824733
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/11/2006
Last updated
10/28/2011
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