Healthcare Provider Details

I. General information

NPI: 1902839251
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: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 ABBEY RD
CHARLOTTESVILLE VA
22911-3543
US

IV. Provider business mailing address

1149 HARRISBURG PIKE
CARLISLE PA
17013-1607
US

V. Phone/Fax

Practice location:
  • Phone: 434-244-4301
  • Fax: 434-244-4339
Mailing address:
  • Phone: 717-240-5520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0201003800
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201003800
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201003800
License Number StateVA

VIII. Authorized Official

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