Provider Demographics
NPI:1063456556
Name:GIANT FOOD STORES, LLC
Entity Type:Organization
Organization Name:GIANT FOOD STORES, LLC
Other - Org Name:MARTIN'S PHARMACY #6498
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, PHARMACY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-240-1506
Mailing Address - Street 1:1149 HARRISBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-1607
Mailing Address - Country:US
Mailing Address - Phone:717-240-1526
Mailing Address - Fax:717-960-4226
Practice Address - Street 1:9645 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4116
Practice Address - Country:US
Practice Address - Phone:804-965-0533
Practice Address - Fax:804-965-0259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHOLD USA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201002724332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008530602Medicaid
VA4824404OtherNCPDP
PHC089OtherMEDICARE B FLU BILLING
P00758645OtherMEDICARE B FLU BILLING - RAIL ROAD
FG1817367OtherDEA
VA008530602Medicaid