=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003848011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE GIANT COMPANY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 11/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 471 S OXFORD VALLEY RD
-----------------------------------------------------
City | FAIRLESS HILLS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19030-4202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-949-8955
-----------------------------------------------------
Fax | 215-949-8963
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1149 HARRISBURG PIKE ATTN: THIRD PARTY COORDINATOR
-----------------------------------------------------
City | CARLISLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17013-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-960-8553
-----------------------------------------------------
Fax | 717-960-1389
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP HEALTH & HOUSEHOLD
-----------------------------------------------------
Name | RAYMOND HOOVER
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 717-960-8553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PP414951L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------