Provider Demographics
NPI:1982644316
Name:GIANT FOOD STORES, LLC
Entity Type:Organization
Organization Name:GIANT FOOD STORES, LLC
Other - Org Name:MARTIN'S PHARMACY #6438
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 1:13700 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2000
Practice Address - Country:US
Practice Address - Phone:804-739-8411
Practice Address - Fax:804-739-8627
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHOLD USA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201003170332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008504849Medicaid
VA09110801OtherMEDICAID DME
P00758645OtherMEDICARE FLU BILLING - RAILROAD
VA4828034OtherNCPDP
PHC089OtherMEDICARE B FLU BILLING
PHC089OtherMEDICARE B FLU BILLING