Healthcare Provider Details

I. General information

NPI: 1467493221
Provider Name (Legal Business Name): GIANT EAGLE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 OLD WILLIAM PENN HWY
EXPORT PA
15632-9367
US

IV. Provider business mailing address

101 KAPPA DR
PITTSBURGH PA
15238-2809
US

V. Phone/Fax

Practice location:
  • Phone: 724-327-5493
  • Fax: 724-773-0691
Mailing address:
  • Phone: 412-968-1550
  • Fax: 412-968-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP414993L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1007285680190
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier039693615009
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPACE
# 3
Identifier870021414
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRRB
# 4
Identifier370009607
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPAID

VIII. Authorized Official

Name: DEBRA B. KRASNOW
Title or Position: DIRECTOR OF MANAGED CARE
Credential: PHARMD
Phone: 412-968-1550