Provider Demographics
NPI:1629000641
Name:THE GIANT COMPANY, LLC
Entity Type:Organization
Organization Name:THE GIANT COMPANY, LLC
Other - Org Name:GIANT PHARMACY #6046
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-885-7454
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:717-960-8553
Mailing Address - Fax:717-960-1389
Practice Address - Street 1:2721 STREET RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2810
Practice Address - Country:US
Practice Address - Phone:215-604-1390
Practice Address - Fax:215-604-0306
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE GIANT COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
PAPP415641L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA21011183Medicaid
3977254OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA1007302990126Medicaid
3977254OtherOTHER ID NUMBER-COMMERCIAL NUMBER