MEDICARE: RISER FOODS COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	021087300	OH
2	3336C0003X	Community/Retail Pharmacy

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00419119	OTHER	OH	MEDICARE RAILROAD FLU

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3665380	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1962417873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISER FOODS COMPANY

Provider Business Mailing Address
First Line	:	101 KAPPA DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-2809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13820 LORAIN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3428
Country	:	US
Telephone Number	:	216-476-4731
Fax Number	:	216-476-4737

Authorized Official
Title or Position	:	DIRECTOR MANAGED CARE
Name	:	DEBRA KRASNOW
Credential	:
Telephone Number	:	412-968-1550

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	10/27/2008

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Directions to “RISER FOODS COMPANY ” Practice Location

Language	Start Address	Practice Location

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