Provider Demographics
NPI:1770044315
Name:NIEDERMANN PHARMACY, INC.
Entity Type:Organization
Organization Name:NIEDERMANN PHARMACY, INC.
Other - Org Name:MONROE COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEDERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:319-393-4944
Mailing Address - Street 1:1790 BLAIRS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2033
Mailing Address - Country:US
Mailing Address - Phone:319-393-4944
Mailing Address - Fax:319-393-6655
Practice Address - Street 1:112 E WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:IA
Practice Address - Zip Code:50170
Practice Address - Country:US
Practice Address - Phone:641-259-4090
Practice Address - Fax:641-259-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy