Provider Demographics
NPI:1326053257
Name:GIANT EAGLE INC
Entity Type:Organization
Organization Name:GIANT EAGLE INC
Other - Org Name:GIANT EAGLE PHARMACY 0075
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:
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 1:1600 W STATE ST
Practice Address - Street 2:NORTHERN LIGHT SHOPPING CENTER
Practice Address - City:BADEN
Practice Address - State:PA
Practice Address - Zip Code:15005-1207
Practice Address - Country:US
Practice Address - Phone:724-869-7220
Practice Address - Fax:724-869-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415028L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00419123OtherRRB
PA1007285680210Medicaid
OH2576707Medicaid
3969877OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA1007285680210Medicaid
PAP00419123OtherRRB