Provider Demographics
NPI:1710052709
Name:ALPENA SUPERMARKET INC. DBA NEIMAN'S FAMILY MARKET
Entity type:Organization
Organization Name:ALPENA SUPERMARKET INC. DBA NEIMAN'S FAMILY MARKET
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-289-3000
Mailing Address - Street 1:1362 RIVER ROAD, BLDG 2
Mailing Address - Street 2:UNIT A&F
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079
Mailing Address - Country:US
Mailing Address - Phone:810-289-3000
Mailing Address - Fax:989-843-7364
Practice Address - Street 1:315 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:MI
Practice Address - Zip Code:48744
Practice Address - Country:US
Practice Address - Phone:989-843-6141
Practice Address - Fax:989-843-6491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010066323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2357324OtherNABP
MI3383907Medicaid
MI2357324Medicaid
MI2357324Medicaid