Provider Demographics
NPI:1336771344
Name:GIANT EAGLE INC
Entity Type:Organization
Organization Name:GIANT EAGLE INC
Other - Org Name:GIANT EAGLE PHARMACY #2455
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE CONTRACTING & CREDENTIALI
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-967-4775
Mailing Address - Street 1:101 KAPPA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2833
Mailing Address - Country:US
Mailing Address - Phone:412-967-4775
Mailing Address - Fax:412-968-1727
Practice Address - Street 1:3220 LEECHBURG RD
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-2860
Practice Address - Country:US
Practice Address - Phone:724-212-2036
Practice Address - Fax:724-212-2037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0536450118OtherMEDICARE PTAN NUMBER