Healthcare Provider Details

I. General information

NPI: 1225144108
Provider Name (Legal Business Name): RIESBECK FOOD MARKETS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 03/07/2023
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56130 NATIONAL ROAD
BRIDGEPORT OH
43912
US

IV. Provider business mailing address

48661 NATIONAL RD
SAINT CLAIRSVILLE OH
43950-9701
US

V. Phone/Fax

Practice location:
  • Phone: 740-633-3368
  • Fax: 740-633-3438
Mailing address:
  • Phone: 740-695-7050
  • Fax: 740-695-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number021592950
License Number StateOH

VIII. Authorized Official

Name: MR. RICHARD L RIESBECK
Title or Position: PRESIDENT & CEO
Credential:
Phone: 740-695-7050