Provider Demographics
NPI:1598764086
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 & CHIEF EXECUTIVE OFFICER
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 ROAD
Mailing Address - Street 2:
Mailing Address - City:ST. CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950
Mailing Address - Country:US
Mailing Address - Phone:740-695-7050
Mailing Address - Fax:740-695-7555
Practice Address - Street 1:104 PLAZA DR
Practice Address - Street 2:
Practice Address - City:ST. CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950
Practice Address - Country:US
Practice Address - Phone:740-695-0274
Practice Address - Fax:740-695-2412
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
OH020732900OtherSTATE PHARMACY BOARD
3657965OtherNCPDP
OH0909673Medicaid
BR3537389OtherDEA LICENSE