Healthcare Provider Details

I. General information

NPI: 1760422174
Provider Name (Legal Business Name): GIANT FOOD STORES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 N WASHINGTON HWY
ASHLAND VA
23005-1623
US

IV. Provider business mailing address

1149 HARRISBURG PIKE
CARLISLE PA
17013-1607
US

V. Phone/Fax

Practice location:
  • Phone: 804-798-8543
  • Fax: 804-752-2154
Mailing address:
  • Phone: 717-240-1526
  • Fax: 717-960-4226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0201002733
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201002733
License Number StateVA

VIII. Authorized Official

Name: MRS. LEIGH SHIRLEY
Title or Position: VICE PRESIDENT, PHARMACY
Credential: RPH
Phone: 717-240-1506