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General NPI Number Information
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NPI Number | 1639267891
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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 | 10/11/2006
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 43760 GREENWAY CORPOATE DRIVE
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City | ASHBURN
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State | VA
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Zip | 20147
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Country | US
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Telephone | 401-238-3820
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Fax | 401-238-3057
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Provider Business Mailing Address
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Address Line | 1385 HANCOCK ST
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City | QUINCY
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State | MA
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Zip | 02169-5103
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Country | US
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Telephone | 401-238-3820
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Fax | 401-238-3057
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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 | 617-770-8982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 201004105
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0201004105
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License Number State | VA
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