Basic Information
| Provider Information | |||||||||
| NPI: | 1467484469 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE GIANT COMPANY, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | MARTINS PHARMACY #6003 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1149 HARRISBURG PIKE | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170131607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172401526 | ||||||||
| FaxNumber: | 7179604226 | ||||||||
| Practice Location | |||||||||
| Address1: | 739 PARK ST | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215023172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017777670 | ||||||||
| FaxNumber: | 3017777673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 11/17/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FARRELL | ||||||||
| AuthorizedOfficialFirstName: | ALISON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, PHARMACY THIRD PARTY | ||||||||
| AuthorizedOfficialTelephone: | 7172401526 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AHOLD USA INC | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | P02373 | MD | N | Suppliers | Pharmacy | 3336C0003X | P-02373 | MD | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 400459100 | 01 | MD | MEDICAID DME | OTHER | 406675800 | 05 | MD | MEDICAID | 2123470 | 01 | OTHER ID NUMBER-COMMERCIAL NUMBER | OTHER | 3810016875 | 05 | WV | MEDICAID |