NPIMap

Organization Active NPI

Giant of Maryland LLC

Doing business as Giant Pharmacy #2301

  • Community/Retail Pharmacy
  • Burtonsville, MD
National Provider Identifier
1306879655
Registry record updated Oct 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PO1391 Issued in MD
Legal business name
GIANT OF MARYLAND LLC
Doing business as
Giant Pharmacy #2301
Practice address
15618 Columbia Pike
Burtonsville, MD 20866
Phone
(301) 421-4493
Fax
(301) 421-1123
NPI assigned
Jul 9, 2006
Last updated
Oct 13, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2011

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

Authorized official

Name
Brad Dayton
Title
Director
Phone
(617) 770-8782

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X PO1391 MD
Pharmacy 333600000X PO1391 MD
Community/Retail Pharmacy 3336C0003X PO1391 MD Primary

Addresses

Primary practice location

15618 Columbia Pike
Burtonsville, MD 20866

Mailing address

15618 Columbia Pike
Burtonsville, MD 20866-1030

Other identifiers 2

IdentifierTypeStateIssuer
695103100MedicaidMD
2115649OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • Giant Pharmacy #2301 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080916000625 TX Part B Supplier - Centralized Flu Biller 7113914219 This NPI is an additional NPI on the enrollment
O20100930054007 MD DME Supplier - PharmacyDME Supplier - Grocery Store 7113914219 Practice locations: Burtonsville, MD

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2171121Giant Pharmacy #230115618 Columbia Pike, Burtonsville, MD 20866Certificate of waiverAug 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Giant of Maryland LLC162 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

15618 Old Columbia Pike
Burtonsville, MD 20866
Phone (301) 421-4493

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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": "1306879655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15618 COLUMBIA PIKE",
            "city": "BURTONSVILLE",
            "state": "MD",
            "postal_code": "208661030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15618 COLUMBIA PIKE",
            "city": "BURTONSVILLE",
            "state": "MD",
            "postal_code": "20866",
            "telephone_number": "301-421-4493",
            "fax_number": "301-421-1123"
        }
    ],
    "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": "617-770-8782"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MD",
            "license": "PO1391",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MD",
            "license": "PO1391",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MD",
            "license": "PO1391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "695103100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2115649",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Giant Pharmacy #2301",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Burtonsville, MD

Sources for this page

  • 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.