NPIMap

Organization Active NPI

Giant of Maryland LLC

  • Community/Retail Pharmacy
  • Centreville, VA
National Provider Identifier
1467485706
Registry record updated Oct 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
0201003058 Issued in VA
Legal business name
GIANT OF MARYLAND LLC
Practice address
5615 Stone Rd
Centreville, VA 20120
Phone
(703) 803-8556
Fax
(703) 803-9549
NPI assigned
Jul 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 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 0201003058 VA
Pharmacy 333600000X 0201003058 VA
Community/Retail Pharmacy 3336C0003X 0201003058 VA Primary

Addresses

Primary practice location

5615 Stone Rd
Centreville, VA 20120

Mailing address

5615 Stone Rd
Centreville, VA 20120

Other identifiers 2

IdentifierTypeStateIssuer
008531242MedicaidVA
4825456OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • GIANT PHARMACY 740 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, VA2 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
O20100930091699 VA DME Supplier - PharmacyDME Supplier - Grocery Store 7113914219 Practice locations: Centreville, VA

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
49D2187237Giant Pharmacy #7405615 Stone Road, Centreville, VA 20120Certificate of waiverJun 28, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Giant of Maryland LLC5615 Stone Rd, Centreville, VA 20120-1618(703) 803-8556 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Ostomy Supplies|Urological Supplies|Surgical Dressings Accepts assignmentParticipating since Sep 1, 2010

National Provider Directory

National Provider Directory
Tax ID family
Ahold USA162 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

5615 Stone Rd
Centreville, VA 20120
Phone (703) 803-8556

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1319760000000",
    "number": "1467485706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5615 STONE RD",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "20120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5615 STONE RD",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "20120",
            "telephone_number": "703-803-8556",
            "fax_number": "703-803-9549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIANT OF MARYLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2011-10-28",
        "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": "VA",
            "license": "0201003058",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "VA",
            "license": "0201003058",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VA",
            "license": "0201003058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008531242",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4825456",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GIANT PHARMACY 740",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centreville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.