Provider Demographics
NPI:1013928241
Name:GIANT EAGLE INC
Entity Type:Organization
Organization Name:GIANT EAGLE INC
Other - Org Name:GIANT EAGLE PHARMACY #0483
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIIOR 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:
Mailing Address - Fax:
Practice Address - Street 1:20111 ROUTE 19
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066
Practice Address - Country:US
Practice Address - Phone:724-772-7420
Practice Address - Fax:724-772-7471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414094L3336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007285680286Medicaid
PA870021414OtherMEDICARE RAILROAD FLU GIANT EAGLE PA
PA0536450023Medicare NSC
PA106431Medicare PIN