Healthcare Provider Details

I. General information

NPI: 1639101645
Provider Name (Legal Business Name): GIANT FOOD STORES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 EASTON AVE
BETHLEHEM PA
18017-4206
US

IV. Provider business mailing address

1149 HARRISBURG PIKE
CARLISLE PA
17013-1607
US

V. Phone/Fax

Practice location:
  • Phone: 610-866-3393
  • Fax: 610-866-4205
Mailing address:
  • Phone: 717-240-5520
  • Fax: 717-960-8371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP414093L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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