Healthcare Provider Details

I. General information

NPI: 1073707337
Provider Name (Legal Business Name): GIANT OF MARYLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13781 CONNECTICUT AVE
SILVER SPRING MD
20906-2916
US

IV. Provider business mailing address

13781 CONNECTICUT AVE
SILVER SPRING MD
20906-2916
US

V. Phone/Fax

Practice location:
  • Phone: 781-380-5611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO4658
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPO4658
License Number StateMD

VIII. Authorized Official

Name: BRAD DAYTON
Title or Position: DIRECTOR
Credential:
Phone: 617-770-8782