Healthcare Provider Details

I. General information

NPI: 1386941326
Provider Name (Legal Business Name): NIEMANN FOODS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 ELM ST
CANTON MO
63435-1685
US

IV. Provider business mailing address

PO BOX C847
QUINCY IL
62306-0847
US

V. Phone/Fax

Practice location:
  • Phone: 573-288-5151
  • Fax: 573-288-0352
Mailing address:
  • Phone: 217-221-5641
  • Fax: 217-221-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2011023099
License Number StateMO

VIII. Authorized Official

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