Provider Demographics
NPI:1275548190
Name:GIANT EAGLE INC
Entity Type:Organization
Organization Name:GIANT EAGLE INC
Other - Org Name:GIANT EAGLE PHARMACY #0015
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASNOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:412-968-1550
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 1:1701 LINCOLN HWY
Practice Address - Street 2:ROUTE 30
Practice Address - City:NORTH VERSAILLES
Practice Address - State:PA
Practice Address - Zip Code:15137-2550
Practice Address - Country:US
Practice Address - Phone:412-824-3221
Practice Address - Fax:412-825-4615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413653L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA870021414OtherRRB
PA1007285680314Medicaid
3949027OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA0536450034Medicare NSC
PA106431Medicare PIN