Healthcare Provider Details

I. General information

NPI: 1780699603
Provider Name (Legal Business Name): RISER FOODS COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5321 WARRENSVILLE CENTER RD
MAPLE HEIGHTS OH
44137-1908
US

IV. Provider business mailing address

101 KAPPA DR
PITTSBURGH PA
15238-2809
US

V. Phone/Fax

Practice location:
  • Phone: 216-332-9592
  • Fax: 216-332-9615
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number021551150
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DEBRA KRASNOW
Title or Position: DIRECTOR MANAGED CARE
Credential:
Phone: 412-968-1550