Provider Demographics
NPI:1780699694
Name:RISER FOODS COMPANY
Entity type:Organization
Organization Name:RISER FOODS COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:
Mailing Address - Fax:
Practice Address - Street 1:8383 TYLER BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4214
Practice Address - Country:US
Practice Address - Phone:440-701-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIANT EAGLE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-29
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3665671OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OH2078362Medicaid
OHP00419119OtherMEDICARE RAILROAD FLU
OHRIFV93981Medicare PIN
OHP00419119OtherMEDICARE RAILROAD FLU