Healthcare Provider Details

I. General information

NPI: 1497760318
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: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27505 CHARDON RD
WICKLIFFE OH
44092-2794
US

IV. Provider business mailing address

101 KAPPA DR
PITTSBURGH PA
15238-2809
US

V. Phone/Fax

Practice location:
  • Phone: 440-944-9387
  • Fax: 440-944-9391
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number21223950
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