=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255364501
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GIANT OF MARYLAND LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12051 ROCKVILLE PIKE
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-1603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-881-2225
-----------------------------------------------------
Fax | 301-388-5190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1149 HARRISBURG PIKE 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 | MR. RAYMOND MCCALL
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 717-960-8553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | PO0272
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PO0272
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PO0272
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------