Provider Demographics
NPI:1194750141
Name:GIANT OF MARYLAND LLC
Entity type:Organization
Organization Name:GIANT OF MARYLAND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR OF MANGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-960-8601
Mailing Address - Street 1:1149 HARRISBURG PIKE
Mailing Address - Street 2:THIRD PARTY COORDINATOR
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-1607
Mailing Address - Country:US
Mailing Address - Phone:717-960-8553
Mailing Address - Fax:717-960-1389
Practice Address - Street 1:6636 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2317
Practice Address - Country:US
Practice Address - Phone:410-487-0111
Practice Address - Fax:410-582-9015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHOLD USA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPO1298332B00000X, 3336C0003X
MDPO1258333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2113950OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MD694702600Medicaid
MD694702600Medicaid