Provider Demographics
NPI:1538765920
Name:KUBAT PHARMACY, LLC
Entity type:Organization
Organization Name:KUBAT PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP MEDICAL OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-301-1307
Mailing Address - Street 1:3206 S 71ST ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3507
Mailing Address - Country:US
Mailing Address - Phone:402-558-1192
Mailing Address - Fax:402-558-0135
Practice Address - Street 1:120 N 27TH ST STE 100A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3286
Practice Address - Country:US
Practice Address - Phone:402-371-3444
Practice Address - Fax:402-371-3566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERCIPIO RESPIRATORY HOLDCO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-10
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026019700Medicaid