Organization
GIANT OF MARYLAND LLC
Active
Other names
GIANT PHARMACY 747
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8782
Entity
Organization
Contact information
Practice address
1450 NORTHPOINT VILLAGE CTR, RESTON, VA 20194-1190
(703) 437-0037
(703) 437-2090
Mailing address
1450 NORTHPOINT VILLAGE CTR, RESTON, VA 20194-1190
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0201003169
VA
333600000X
Pharmacy
0201003169
VA
3336C0003X
Community/Retail Pharmacy
Primary
0201003169
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008504768
—
VA
01
—
4827931
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/09/2006
Last updated
10/28/2011
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