Healthcare Provider Details

I. General information

NPI: 1700891629
Provider Name (Legal Business Name): GIANT EAGLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5990 UNIVERSITY BLVD SUITE 4
MOON TWP PA
15108-4229
US

IV. Provider business mailing address

PO BOX 643559
PITTSBURGH PA
15264-3559
US

V. Phone/Fax

Practice location:
  • Phone: 412-269-0254
  • Fax: 412-299-5673
Mailing address:
  • Phone: 412-968-1529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP414133L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1007285680276
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier870021414
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICARE RAILROAD FLU GIANT EAGLE PA

VIII. Authorized Official

Name: KELLY ANNE ZMARZLY
Title or Position: PHARMACY MANAGED CARE
Credential:
Phone: 412-968-1529