1568402873 NPI number — GIANT FOOD STORES, LLC

Table of content: (NPI 1568402873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568402873 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:
1568402873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
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:
3107-15 BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLONIAL HEIGHTS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23834-2405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-520-4106
Provider Business Practice Location Address Fax Number:
804-520-8396
Provider Enumeration Date:
06/07/2006

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:  0201003767 , 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: 0201003767 , 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: 4836714 . This is a "NCPDP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 008513325 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00758645 . This is a "MEDICARE FLU - RAIL ROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: PHC089 . This is a "MEDICARE FLU" identifier . This identifiers is of the category "OTHER".




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