Provider Demographics
NPI:1174358675
Name:NIEDERMANN PHARMACY, INC.
Entity type:Organization
Organization Name:NIEDERMANN PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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:319-393-4944
Practice Address - Street 1:211 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5845
Practice Address - Country:US
Practice Address - Phone:641-758-3350
Practice Address - Fax:641-758-3351
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIEDERMANN PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy