Provider Demographics
NPI:1083646004
Name:GIANT FOOD STORES LLC
Entity Type:Organization
Organization Name:GIANT FOOD STORES LLC
Other - Org Name:GIANT PHARMACY #6305
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
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:
Mailing Address - Fax:
Practice Address - Street 1:16001606 NAY AUG AVENUE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509
Practice Address - Country:US
Practice Address - Phone:570-343-7940
Practice Address - Fax:570-343-8827
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHOLD USA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415786L333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007302990167Medicaid
3979044OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3910690059Medicare NSC