Healthcare Provider Details

I. General information

NPI: 1518990860
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: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 PULASKI HWY
EDGEWOOD MD
21040-1611
US

IV. Provider business mailing address

1901 PULASKI HWY
EDGEWOOD MD
21040-1611
US

V. Phone/Fax

Practice location:
  • Phone: 410-676-1400
  • Fax: 410-676-5002
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPO0276
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BOB STONE
Title or Position: DIR 3RD PARTY AND MANAGED CARE
Credential:
Phone: 781-380-5609