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NPI 1063447019

NPI 1063447019 : GIANT OF MARYLAND LLC : BALTIMORE, MD

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General NPI Number Information
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    NPI Number           |    1063447019
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    Entity Type          |    Organization 
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    Legal Business Name  |    GIANT OF MARYLAND LLC 
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Dates
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    Enumeration Date     |    07/11/2006
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    Last Update Date     |    09/23/2011
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Provider Practice Location Address
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    Address Line         |    7944 HONEYGO BLVD 
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    City                 |    BALTIMORE
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    State                |    MD
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    Zip                  |    21236-4919
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    Country              |    US
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    Telephone            |    410-931-7533
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    Fax                  |    410-931-7531
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Provider Business Mailing Address
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    Address Line         |    7944 HONEYGO BLVD 
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    City                 |    BALTIMORE
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    State                |    MD
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    Zip                  |    21236-4919
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    Country              |    US
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    Telephone            |    
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    Fax                  |    
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Authorized Official
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    Title or Position    |    DIRECTOR
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    Name                 |     BRAD  DAYTON 
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    Credential           |    
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    Telephone            |    617-770-8782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    333600000X
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    Taxonomy Name        |    Pharmacy
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    License Number       |    PO1442
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    License Number State |    MD
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Taxonomy #2
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    Taxonomy Code        |    332B00000X
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    Taxonomy Name        |    Durable Medical Equipment & Medical Supplies
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    License Number       |    4081710074
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    License Number State |    MD
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Taxonomy #3
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    Taxonomy Code        |    3336C0003X
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    Taxonomy Name        |    Community/Retail Pharmacy
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    License Number       |    
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    License Number State |    
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