1922850536 NPI number — NIEMANN FOODS INC

Table of content: (NPI 1922850536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922850536 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:
Provider Other Organization Name Type Code:
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:
1922850536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 N 12TH ST
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:
62301-1996
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-221-5615
Provider Business Mailing Address Fax Number:
217-221-5615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2140 E 116TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-249-8572
Provider Business Practice Location Address Fax Number:
317-663-1023
Provider Enumeration Date:
04/05/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AWERKAMP
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
217-221-5615

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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