Organization
GIANT OF MARYLAND LLC
Active
Other names
GIANT PHARMACY 103
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD DAYTON (DIRECTOR)
(617) 770-8782
Entity
Organization
Contact information
Practice address
6626 RITCHIE HWY, GLEN BURNIE, MD 21061-2317
(410) 768-0120
(410) 768-0816
Mailing address
6626 RITCHIE HWY, GLEN BURNIE, MD 21061-2317
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PO0255
MD
333600000X
Pharmacy
PO0255
MD
3336C0003X
Community/Retail Pharmacy
Primary
PO0255
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2101412
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
691303200
—
MD
Enumeration date
07/11/2006
Last updated
10/13/2011
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