Provider Demographics
NPI:1740297761
Name:GIANT EAGLE INC
Entity type:Organization
Organization Name:GIANT EAGLE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:
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 1:208 GIANT ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2440
Practice Address - Country:US
Practice Address - Phone:304-599-2369
Practice Address - Fax:304-599-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVMPO5523203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000006Medicaid
5054058OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WVGIFV95821Medicare PIN
5054058OtherOTHER ID NUMBER-COMMERCIAL NUMBER