Healthcare Provider Details

I. General information

NPI: 1609881515
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: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 W HIGH ST
MIDDLEFIELD OH
44062-9212
US

IV. Provider business mailing address

101 KAPPA DR
PITTSBURGH PA
15238-2809
US

V. Phone/Fax

Practice location:
  • Phone: 440-632-5587
  • Fax: 440-632-0653
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEBORAH J ELMS
Title or Position: INSURANCE CONTRACTING & CREDENTIALI
Credential:
Phone: 412-967-4775