Provider Demographics
NPI:1225037617
Name:RIESBECK FOOD MARKETS, INC.
Entity Type:Organization
Organization Name:RIESBECK FOOD MARKETS, INC.
Other - Org Name:RIESBECK'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CHIEF EXECUTIVE OFFIC
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIESBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-695-7050
Mailing Address - Street 1:48661 NATIONAL RD W
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9701
Mailing Address - Country:US
Mailing Address - Phone:740-695-7050
Mailing Address - Fax:740-695-7555
Practice Address - Street 1:2200 JUNE PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-6377
Practice Address - Country:US
Practice Address - Phone:740-450-7859
Practice Address - Fax:740-450-7943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3671307OtherNCPDP
OH021350650OtherSTATE PHARMACY LICENSE
OH2371259Medicaid
OH2371259Medicaid