MEDICARE: JOHN NIED PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	18271	WI
2	183500000X	Pharmacist	122477	MN

General Provider Information

NPI Number	:	1174159230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN NIED PHARMD

Provider Business Mailing Address
First Line	:	10930 UNIVERSITY AVE NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-6120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10930 UNIVERSITY AVE NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-6120
Country	:	US
Telephone Number	:	763-755-6316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2020
Last Update Date	:	03/19/2020

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Directions to “ JOHN NIED PHARMD” Practice Location

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