Provider Demographics
NPI:1992846737
Name:RISER FOODS COMPANY
Entity Type:Organization
Organization Name:RISER FOODS COMPANY
Other - Org Name:GIANT EAGLE PHARMACY #5830
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE CONTRACTING & CREDENTIALI
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-967-4775
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:412-968-1561
Practice Address - Street 1:24601 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5609
Practice Address - Country:US
Practice Address - Phone:216-831-8080
Practice Address - Fax:216-831-5330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIANT EAGLE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-12
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-16436003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2720407Medicaid
OHP00419119OtherMEDICARE RAILROAD FLU RISER OHIO
OH2720407Medicaid
OH1262260039Medicare NSC