Healthcare Provider Details

I. General information

NPI: 1841558012
Provider Name (Legal Business Name): NIEMANN FOODS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 S MAIN ST
LEWISTOWN IL
61542-1565
US

IV. Provider business mailing address

PO BOX 847
QUINCY IL
62306-0847
US

V. Phone/Fax

Practice location:
  • Phone: 309-547-3731
  • Fax: 309-547-2040
Mailing address:
  • Phone: 217-221-5615
  • Fax: 217-221-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054017962
License Number StateIL

VIII. Authorized Official

Name: CHRISTOPHER NIEMANN
Title or Position: EVP/CFO
Credential:
Phone: 217-221-5615