1407861321 NPI number — RISER FOODS COMPANY

Table of content: (NPI 1407861321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407861321 NPI number — RISER FOODS COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RISER FOODS COMPANY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GIANT EAGLE PHARMACY 4009
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407861321
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1825 SNOW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44134-2722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-739-4120
Provider Business Practice Location Address Fax Number:
216-739-4123
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  02115750003007624 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00419119 . This is a "RRB" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2130536 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3667221 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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