Provider Demographics
NPI:1225144108
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 & CEO
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
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:740-695-7045
Practice Address - Street 1:56130 NATIONAL ROAD
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:OH
Practice Address - Zip Code:43912
Practice Address - Country:US
Practice Address - Phone:740-633-3368
Practice Address - Fax:740-633-3438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0215929503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2657183Medicaid
OH3674620OtherNCPDP
WV3810018623Medicaid
OH021592950OtherSTATE PHARMACY BOARD
OH021592950OtherSTATE PHARMACY BOARD