Organization
NIEMANN FOODS INC
Active
Other names
COUNTY MARKET PHARMACY 228
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER NIEMANN (EVP/CFO)
(217) 221-5612
Entity
Organization
Contact information
Practice address
1903 W MONROE ST, SPRINGFIELD, IL 62704-1530
(217) 787-2830
(217) 787-4520
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
054016035
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1479977
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/31/2006
Last updated
09/27/2021
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