Provider Demographics
NPI:1407861321
Name:RISER FOODS COMPANY
Entity Type:Organization
Organization Name:RISER FOODS COMPANY
Other - Org Name:GIANT EAGLE PHARMACY 4009
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR MANAGED CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASNOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:412-968-1550
Mailing Address - Street 1:101 KAPPA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1825 SNOW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2722
Practice Address - Country:US
Practice Address - Phone:216-739-4120
Practice Address - Fax:216-739-4123
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIANT EAGLE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-29
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021157500030076243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00419119OtherRRB
OH2130536Medicaid
3667221OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OH1262260026Medicare NSC
OHRIFV93981Medicare PIN