Provider Demographics
NPI:1871508788
Name:RISER FOODS COMPANY
Entity Type:Organization
Organization Name:RISER FOODS COMPANY
Other - Org Name:GIANT EAGLE PHARMACY 1284
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR MANAGED CARE
Authorized Official - Prefix:
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 1:31990 WALKER RD
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-2045
Practice Address - Country:US
Practice Address - Phone:440-933-9598
Practice Address - Fax:440-933-7571
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIANT EAGLE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-29
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021087350333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2078577Medicaid
3665657OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OHP00419119OtherRRB
OH1262260013Medicare NSC
OH2078577Medicaid