Provider Demographics
NPI:1851674774
Name:NIEMAN, MICHAEL R (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:NIEMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14950 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7042
Mailing Address - Country:US
Mailing Address - Phone:636-527-7873
Mailing Address - Fax:636-527-7834
Practice Address - Street 1:14950 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7042
Practice Address - Country:US
Practice Address - Phone:636-527-7873
Practice Address - Fax:636-527-7834
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000164237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist