Giant of Maryland LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

0201004105 Issued in VA

Legal business name

GIANT OF MARYLAND LLC

Doing business as

Giant Pharmacy #791

Practice address

43760 Greenway Corpoate Drive
Ashburn, VA 20147

Phone

(401) 238-3820

Fax

(401) 238-3057

NPI assigned

Oct 11, 2006

Last updated

Oct 20, 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

(617) 770-8982

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Giant Pharmacy #791 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319068800000",
    "number": "1639267891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1385 HANCOCK ST",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021695103",
            "telephone_number": "401-238-3820",
            "fax_number": "401-238-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43760 GREENWAY CORPOATE DRIVE",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "20147",
            "telephone_number": "401-238-3820",
            "fax_number": "401-238-3057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIANT OF MARYLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2011-10-20",
        "status": "A",
        "authorized_official_last_name": "DAYTON",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "617-770-8982"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "VA",
            "license": "201004105",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VA",
            "license": "0201004105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010324092",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4839467",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Giant Pharmacy #791",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nick Gentile, LPC
• Jennifer Lynn Gentrup
• Audrey Gentry-Brown, CLC
• Gauri M Ghan, DPT
• Giant of Maryland LLC (Giant Pharmacy 262)
• Giant of Maryland LLC (Giant Pharmacy 797)
• Noeris Gil
• Mallory Giles, CPNP-PC
• Jessica Gilleo
• Kathryn Gillette

• Community/Retail Pharmacy in Ashburn, VA
• Providers in Ashburn, VA by specialty
• Community/Retail Pharmacy in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.