Healthcare Provider Details

I. General information

NPI: 1083951727
Provider Name (Legal Business Name): GIANT EAGLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 KAPPA DR
PITTSBURGH PA
15238-2809
US

IV. Provider business mailing address

101 KAPPA DR
PITTSBURGH PA
15238-2809
US

V. Phone/Fax

Practice location:
  • Phone: 412-967-3710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDN004457
License Number StatePA

VIII. Authorized Official

Name: JEFFREY LUCCHINO
Title or Position: TEAM MEMBER DIETITIAN
Credential: RD
Phone: 412-967-3710