1093754871 NPI number — GIANT FOOD STORES, LLC

Table of content: AMY WILLIS PITTS FNP (NPI 1033761036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093754871 NPI number — GIANT FOOD STORES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GIANT FOOD STORES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093754871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1149 HARRISBURG PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLISLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17013-1607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-240-1526
Provider Business Mailing Address Fax Number:
717-960-4226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7324 BELL CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23111-3545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-746-8131
Provider Business Practice Location Address Fax Number:
804-730-7495
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHIRLEY
Authorized Official First Name:
LEIGH
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT PHARMACY
Authorized Official Telephone Number:
717-240-1506

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0201002877 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 0201002877 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4825608 . This is a "NCPDP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 008536139 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PHC089 . This is a "MEDICARE B FLU BILLING" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00758645 . This is a "MEDICARE FLU BILLING - RAIL ROAD" identifier . This identifiers is of the category "OTHER".




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