Healthcare Provider Details

I. General information

NPI: 1619024767
Provider Name (Legal Business Name): NIEMANN FOODS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 W WASHINGTON ST
PITTSFIELD IL
62363-1372
US

IV. Provider business mailing address

PO BOX C847
QUINCY IL
62306-0847
US

V. Phone/Fax

Practice location:
  • Phone: 217-285-5515
  • Fax: 217-285-1326
Mailing address:
  • Phone: 217-221-5641
  • Fax: 217-221-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054016065
License Number StateIL

VIII. Authorized Official

Name: CHRISTOPHER NIEMANN
Title or Position: EVP CFO
Credential:
Phone: 217-221-5612