Provider Demographics
NPI:1891944757
Name:RISER FOODS COMPANY
Entity Type:Organization
Organization Name:RISER FOODS COMPANY
Other - Org Name:GIANT EAGLE PHARMACY #1238
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:B
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:412-968-1550
Mailing Address - Fax:412-968-1727
Practice Address - Street 1:4453 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-1907
Practice Address - Country:US
Practice Address - Phone:440-967-1220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIANT EAGLE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-16
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0218970503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2866064Medicaid
OHP00419119OtherRRB
OH1262260053Medicare NSC
OHP00419119OtherRRB