Healthcare Provider Details

I. General information

NPI: 1205869559
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: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 FAIRMONT DR
BOWIE MD
20716-3738
US

IV. Provider business mailing address

3500 CRAIN HWY
BOWIE MD
20716-1303
US

V. Phone/Fax

Practice location:
  • Phone: 301-352-2364
  • Fax: 301-352-3190
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO1935
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPO1935
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPO1935
License Number StateMD

VIII. Authorized Official

Name: IRA KRESS
Title or Position: PRESIDENT
Credential:
Phone: 207-885-2518