Healthcare Provider Details

I. General information

NPI: 1205861267
Provider Name (Legal Business Name): GIANT OF MARYLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7142 ARLINGTON RD
BETHESDA MD
20814-2915
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 301-492-5161
  • Fax: 301-492-5190
Mailing address:
  • Phone: 717-960-8553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP03083
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP03083
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP03083
License Number StateMD

VIII. Authorized Official

Name: MR. RAYMOND MCCALL
Title or Position: SVP OF HEALTH & HOUSEHOLD
Credential: RPH
Phone: 717-960-8553