Healthcare Provider Details

I. General information

NPI: 1629001979
Provider Name (Legal Business Name): GIANT OF MARYLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 BRENTWOOD RD NE
WASHINGTON DC
20018-1000
US

IV. Provider business mailing address

1149 HARRISBURG PIKE THIRD PARTY COORDINATOR
CARLISLE PA
17013-1607
US

V. Phone/Fax

Practice location:
  • Phone: 202-281-3901
  • Fax: 202-281-3903
Mailing address:
  • Phone: 717-960-8553
  • Fax: 717-960-1389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberRX0200327
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberRX0200327
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRX0200327
License Number StateDC

VIII. Authorized Official

Name: GAYLE SHIELDS
Title or Position: VP
Credential: RPH
Phone: 301-957-5004