Giant of Maryland LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PO0292 Issued in MD

Legal business name

GIANT OF MARYLAND LLC

Doing business as

Giant Pharmacy 162

Practice address

8899 Woodyard Rd
Clinton, MD 20735-2754

Phone

(301) 868-8790

Fax

(301) 868-5014

NPI assigned

Jul 9, 2006

Last updated

Oct 13, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brad Dayton

Title

Director

Phone

(781) 380-8782

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• GIANT PHARMACY 162 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318464000000",
    "number": "1235162587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8899 WOODYARD RD",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207352754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8899 WOODYARD RD",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207352754",
            "telephone_number": "301-868-8790",
            "fax_number": "301-868-5014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIANT OF MARYLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2011-10-13",
        "status": "A",
        "authorized_official_last_name": "DAYTON",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "781-380-8782"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MD",
            "license": "PO0292",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MD",
            "license": "PO0292",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MD",
            "license": "PO0292",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "689304000",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2111401",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GIANT PHARMACY 162",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tomika S Gaymon, CNM
• Brook Gebeyehu, MD
• Madison Sinclaire Gee, LMSW
• George E. Urban, Jr MD PA
• Valentine Kintang N Ghun Sr.
• Latyra Gibbs, MD
• George E. Gilbert, M.D., PH.D.
• Michael Gillespie, M.D.
• Molly Louvnia Gilmore, CNA
• Glenn R. Edgecombe, MD,PC

• Community/Retail Pharmacy in Clinton, MD
• Providers in Clinton, MD by specialty
• Community/Retail Pharmacy in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.