MEDICARE: GIANT FOOD STORES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0201003537	VA
2	3336C0003X	Community/Retail Pharmacy	0201003537	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	PHC089	OTHER		MEDICARE FLU BILLING
5	P00758645	OTHER		MEDICARE FLU BILLING - RAIL ROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4833213	OTHER	VA	NCPDP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306886189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIANT FOOD STORES, LLC

Provider Business Mailing Address
First Line	:	1149 HARRISBURG PIKE
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-1607
Country	:	US
Telephone Number	:	717-240-1526
Fax Number	:	717-960-4226

Provider Business Practice Location Address
First Line	:	4591 S LABURNUM AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23231-2421
Country	:	US
Telephone Number	:	804-226-4933
Fax Number	:	804-226-6991

Authorized Official
Title or Position	:	VICE PRESIDENT - PHARMACY
Name	:	MRS. LEIGH SHIRLEY
Credential	:	RPH
Telephone Number	:	717-240-1506

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	03/07/2023

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Directions to “GIANT FOOD STORES, LLC ” Practice Location

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