Provider Demographics
NPI:1083902860
Name:THE GIANT COMPANY, LLC
Entity Type:Organization
Organization Name:THE GIANT COMPANY, LLC
Other - Org Name:GIANT PHARMACY #6468
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: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 1:2550 GRANT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2225
Practice Address - Country:US
Practice Address - Phone:215-464-8140
Practice Address - Fax:215-464-8183
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHOLD USA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA994821543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00758645OtherRR MEDICARE FLU BILLING
PHC089OtherCENTRALIZED FLU BILLING
PA1007302990271Medicaid
PA1007302990271Medicaid