Provider Demographics
NPI:1508807314
Name:GIANT EAGLE, INC
Entity Type:Organization
Organization Name:GIANT EAGLE, INC
Other - Org Name:GIANT EAGLE PHARMACY #0081
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:B
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:412-968-1550
Mailing Address - Fax:412-968-1561
Practice Address - Street 1:5142 ROUTE 30
Practice Address - Street 2:SUITE 140
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6692
Practice Address - Country:US
Practice Address - Phone:724-836-7613
Practice Address - Fax:724-850-7993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415194L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007285680245Medicaid
PA039719615209OtherPACE
PA106431OtherMEDICARE RAILROAD FLU GIANT EAGLE PA
PA370009894OtherPAID PRESCRIPTIONS
PA106431Medicare PIN
PA1007285680245Medicaid