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Provider Information for 1568402873


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GIANT FOOD STORES, LLC

Other Names:  
Doing Business As: 
MARTIN'S PHARMACY #6494

Organization Subpart: YES

NPI: 1568402873
Last Updated: 2023-03-07
Certification Date:

Details

NameValue
NPI1568402873
Enumeration Date2006-06-07
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: Mrs. LEIGH SHIRLEY RPh
Title: Vice President - Pharmacy
Phone: 7172401506
Mailing Address 1149 HARRISBURG PIKE
CARLISLE, PA 17013-1607
United States

Phone: 717-240-1526 | Fax:717-960-4226
 
Primary Practice Address 3107-15 BOULEVARD
COLONIAL HEIGHTS, VA 23834-2405
United States

Phone: 804-520-4106 | Fax:804-520-8396
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDVA008513325
Other (non-Medicare)VA4836714NCPDP
Other (non-Medicare)P00758645Medicare Flu - Rail Road
Other (non-Medicare)PHC089Medicare Flu
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies VA0201003767
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyVA0201003767