Healthcare Provider Details

I. General information

NPI: 1326064361
Provider Name (Legal Business Name): NIEMANN FOODS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 JASON PL
CHATHAM IL
62629-2018
US

IV. Provider business mailing address

PO BOX C847
QUINCY IL
62306-0847
US

V. Phone/Fax

Practice location:
  • Phone: 217-483-2496
  • Fax: 217-483-5772
Mailing address:
  • Phone: 217-221-5641
  • Fax: 217-221-5929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054.019852
License Number StateIL

VIII. Authorized Official

Name: ARTHUR AWERKAMP
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 217-221-5615