1164437083 NPI number — GIANT EAGLE INC

Table of content: DR. ROBERT BRUCE HENRY PH.D. (NPI 1891791554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164437083 NPI number — GIANT EAGLE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GIANT EAGLE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GIANT EAGLE PHARMACY #1682
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164437083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 KAPPA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15238-2809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 COTTONWOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N CAMBRIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15714-1344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-948-9732
Provider Business Practice Location Address Fax Number:
814-951-0163
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ELMS
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
INSURANCE CONTRACTING & CREDENTIALI
Authorized Official Telephone Number:
412-967-4775

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1007285680004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00419123 . This is a "MEDICARE RAILROAD FLU GIANT EAGLE PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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