Provider Demographics
NPI:1891700712
Name:GIANT EAGLE INC
Entity Type:Organization
Organization Name:GIANT EAGLE INC
Other - Org Name:GIANT EAGLE PHARMACY 0046
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:PHARMACY SERVICES
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 1:344 GOUCHER ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3423
Practice Address - Country:US
Practice Address - Phone:814-288-5843
Practice Address - Fax:814-288-6784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414124L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA870021414OtherRRB
PA1007285680297Medicaid
PA1143590Medicaid
PA870021414OtherRRB
PA1143590Medicaid