Provider Demographics
NPI:1558473496
Name:NIEMANN FOODS INC
Entity Type:Organization
Organization Name:NIEMANN FOODS INC
Other - Org Name:COUNTY MARKET PHARMACY 227
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-221-5612
Mailing Address - Street 1:PO BOX C847
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62306-0847
Mailing Address - Country:US
Mailing Address - Phone:217-221-5649
Mailing Address - Fax:217-221-5915
Practice Address - Street 1:2777 S 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-4071
Practice Address - Country:US
Practice Address - Phone:217-744-2296
Practice Address - Fax:217-744-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
IL0540160343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370475175004Medicaid
1479989OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4871210003Medicare NSC