NPIMap

Organization Active NPI

Giant of Maryland LLC

Doing business as Giant #343

  • Community/Retail Pharmacy
  • Lusby, MD
National Provider Identifier
1487837415
Registry record updated Oct 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
P04686 Issued in MD
Legal business name
GIANT OF MARYLAND LLC
Doing business as
Giant #343
Practice address
11740 Rousby Hall Rd
Lusby, MD 20657-2606
Phone
(410) 394-2170
Fax
(410) 394-2172
NPI assigned
Dec 13, 2007
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X P04686 MD
Community/Retail Pharmacy 3336C0003X P04686 MD Primary

Addresses

Primary practice location

11740 Rousby Hall Rd
Lusby, MD 20657-2606

Mailing address

11740 Rousby Hall Rd
Lusby, MD 20657-2606
Phone (410) 394-2170

Other identifiers 2

IdentifierTypeStateIssuer
0161161 00MedicaidMD
2133786OtherMDNCPDP

Other names 1

  • Giant #343 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
O20100930008044 MD DME Supplier - PharmacyDME Supplier - Grocery Store 7113914219 Practice locations: Lusby, 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
21D2186359Giant Pharmacy #34311740 Rousby Hall Road, Lusby, MD 20657Certificate of waiverJun 15, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Giant of Maryland LLC11740 Rousby Hall Rd, Lusby, MD 20657-2606(410) 394-2170 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
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

11740 Rousby Hall Rd
Lusby, MD 20657
Phone (410) 394-2170

Practitioners & affiliated clinicians

Practitioners 2

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": "1197504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318464000000",
    "number": "1487837415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11740 ROUSBY HALL RD",
            "city": "LUSBY",
            "state": "MD",
            "postal_code": "206572606",
            "telephone_number": "410-394-2170",
            "fax_number": "410-394-2172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11740 ROUSBY HALL RD",
            "city": "LUSBY",
            "state": "MD",
            "postal_code": "206572606",
            "telephone_number": "410-394-2170",
            "fax_number": "410-394-2172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIANT OF MARYLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-13",
        "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": "P04686",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MD",
            "license": "P04686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0161161 00",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2133786",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Giant #343",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lusby, 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.