Provider Demographics
NPI:1558507459
Name:GIANT EAGLE, INC
Entity Type:Organization
Organization Name:GIANT EAGLE, INC
Other - Org Name:GIANT EAGLE PHARMACY #1435
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:MS
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:
Practice Address - Street 1:7229 SHARON-WARREN ROAD
Practice Address - Street 2:GIANT EAGLE PHARMACY #1435
Practice Address - City:BROOKFIELD
Practice Address - State:OH
Practice Address - Zip Code:44403
Practice Address - Country:US
Practice Address - Phone:330-448-6480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0208857003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH870021414OtherMEDICARE RAILROAD FLU (GIANT EAGLE) OH
OH0536450073Medicare NSC
OH106431Medicare PIN