Provider Demographics
NPI:1235144163
Name:GIANT EAGLE, INC.
Entity Type:Organization
Organization Name:GIANT EAGLE, INC.
Other - Org Name:GIANT EAGLE PHARMACY #4237
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE CONTRACTING & CREDENTIALI
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-967-4775
Mailing Address - Street 1:101 KAPPA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2809
Mailing Address - Country:US
Mailing Address - Phone:412-967-4775
Mailing Address - Fax:
Practice Address - Street 1:2067 INTERCHANGE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-8315
Practice Address - Country:US
Practice Address - Phone:814-868-7923
Practice Address - Fax:814-864-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415057L3336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007285680338Medicaid
PAP00419123OtherMEDICARE RR FLU
0536450115OtherMEDICARE PTAN NUMBER
3970250OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA117931Medicare PIN