MEDICARE: GIANT FOOD STORES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962775973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIANT FOOD STORES LLC

Provider Business Mailing Address
First Line	:	1149 HARRISBURG PIKE
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-1607
Country	:	US
Telephone Number	:	717-240-5520
Fax Number	:	717-960-8371

Provider Business Practice Location Address
First Line	:	107 S MAIN ST
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2832
Country	:	US
Telephone Number	:	215-699-7555
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, THIRD PARTY PHARMACY
Name	:	ALISON FARRELL
Credential	:
Telephone Number	:	717-240-1526

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	03/05/2013

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Directions to “GIANT FOOD STORES LLC ” Practice Location

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