Organization
NIEMANN FOODS INC
Active
Other names
County Market Pharmacy 518
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER NIEMANN (EVP / CFO)
(217) 221-5615
Entity
Organization
Contact information
Practice address
2901 W KIRBY AVE, CHAMPAIGN, IL 61821-5301
(217) 351-3108
(217) 351-3128
Mailing address
PO BOX C847, QUINCY, IL 62306-0847
(217) 221-5615
(217) 221-5915
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054-018082
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2136914
PK
—
Enumeration date
09/13/2012
Last updated
09/27/2021
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