Provider Demographics
NPI:1467484469
Name:THE GIANT COMPANY, LLC
Entity Type:Organization
Organization Name:THE GIANT COMPANY, LLC
Other - Org Name:MARTINS PHARMACY #6003
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PHARMACY THIRD PARTY
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-240-1526
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 1:739 PARK ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3172
Practice Address - Country:US
Practice Address - Phone:301-777-7670
Practice Address - Fax:301-777-7673
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHOLD USA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP02373333600000X
MDP-023733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400459100OtherMEDICAID DME
MD406675800Medicaid
2123470OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WV3810016875Medicaid
MD400459100OtherMEDICAID DME