Healthcare Provider Details

I. General information

NPI: 1558606327
Provider Name (Legal Business Name): NIEMANN FOODS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E CARPENTER ST
SPRINGFIELD IL
62702-5128
US

IV. Provider business mailing address

PO BOX C847
QUINCY IL
62306-0847
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-3193
  • Fax: 217-528-3196
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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054.018139
License Number StateIL

VIII. Authorized Official

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