Provider Demographics
NPI:1932260767
Name:RISER FOODS COMPANY
Entity Type:Organization
Organization Name:RISER FOODS COMPANY
Other - Org Name:GIANT EAGLE PHARMACY #0199
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 1:34325 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-3169
Practice Address - Country:US
Practice Address - Phone:440-327-8085
Practice Address - Fax:440-327-8151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIANT EAGLE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-16369503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00419123OtherMEDICARE RAILROAD FLU (TAMARKIN) OH
OH2724592Medicaid
OHRIFV93991Medicare PIN
OH2724592Medicaid