MEDICARE: GIANT OF MARYLAND 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	0201003049	VA
2	333600000X	Pharmacy	0201003049	VA
3	3336C0003X	Community/Retail Pharmacy	0201003049	VA

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	4802662	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1396778635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIANT OF MARYLAND LLC

Provider Business Mailing Address
First Line	:	1149 HARRISBURG PIKE
Second Line	:	THIRD PARTY COORDINATOR
City	:	CARLISLE
State	:	PA
Zip	:	17013-1607
Country	:	US
Telephone Number	:	717-960-8553
Fax Number	:

Provider Business Practice Location Address
First Line	:	3480 S JEFFERSON ST
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-3104
Country	:	US
Telephone Number	:	703-931-1333
Fax Number	:	703-933-6190

Authorized Official
Title or Position	:	SVP OF HEALTH & HOUSEHOLD
Name	:	MR. RAYMOND MCCALL
Credential	:	RPH
Telephone Number	:	717-960-5666

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	06/19/2017

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Directions to “GIANT OF MARYLAND LLC ” Practice Location

Language	Start Address	Practice Location

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