Healthcare Provider Details

I. General information

NPI: 1316137516
Provider Name (Legal Business Name): GIANT OF MARYLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 PLANK RD
FREDERICKSBURG VA
22407-6227
US

IV. Provider business mailing address

5701 PLANK ROAD
WEST FREDERICKBURG VA
22407
US

V. Phone/Fax

Practice location:
  • Phone: 781-380-5611
  • Fax: 781-380-5617
Mailing address:
  • Phone: 781-380-5611
  • Fax: 781-380-5617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRAD DAYTON
Title or Position: DIRECTOR
Credential:
Phone: 617-770-8732