Provider Demographics
NPI:1902566680
Name:KUBAT PHARMACY ASHLAND, LLC
Entity Type:Organization
Organization Name:KUBAT PHARMACY ASHLAND, LLC
Other - Org Name:ASHLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:531-233-4455
Mailing Address - Street 1:4924 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3219
Mailing Address - Country:US
Mailing Address - Phone:402-558-8888
Mailing Address - Fax:402-558-7388
Practice Address - Street 1:1401 SILVER ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:NE
Practice Address - Zip Code:68003-1845
Practice Address - Country:US
Practice Address - Phone:402-944-3303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERCIPIO KP HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-22
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10027007300Medicaid