Organization
NIEMANN FOODS INC
Active
Other names
County Market Pharmacy 375
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER NIEMANN (EVP/CFO)
(217) 221-5612
Entity
Organization
Contact information
Practice address
1208 S MAIN ST, PALMYRA, MO 63461-1901
(573) 769-0343
(573) 769-0344
Mailing address
PO BOX C847, QUINCY, IL 62306-0847
(217) 221-5641
(217) 221-5915
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2011002754
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2127638
PK
—
05
—
606505907
—
MO
Enumeration date
01/31/2011
Last updated
09/27/2021
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