1821369224 NPI number — NIEMANN FOODS INC

Table of content: (NPI 1821369224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821369224 NPI number — NIEMANN FOODS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NIEMANN FOODS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COUNTY MARKET PHARMACY 212
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821369224
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX C847
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUINCY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62306-0847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-221-5615
Provider Business Mailing Address Fax Number:
217-221-5915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 W CLINTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSHVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62681-1246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-322-3383
Provider Business Practice Location Address Fax Number:
217-322-6033
Provider Enumeration Date:
01/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NIEMANN
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP / CFO
Authorized Official Telephone Number:
217-221-5615

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  054017868 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1486390 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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