Healthcare Provider Details

I. General information

NPI: 1275566523
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: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 CONCORD PIKE
WILMINGTON DE
19803-1461
US

IV. Provider business mailing address

1149 HARRISBURG PIKE
CARLISLE PA
17013-1607
US

V. Phone/Fax

Practice location:
  • Phone: 302-475-6572
  • Fax: 302-477-5190
Mailing address:
  • Phone: 717-240-5520
  • Fax: 717-960-8371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberA30000593
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberA30000593
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberA30000593
License Number StateDE

VIII. Authorized Official

Name: ALISON FARRELL
Title or Position: DIRECTOR, PHARMACY THIRD PARTY
Credential:
Phone: 717-240-1526