Provider Demographics
NPI:1326042342
Name:KUBAT PHARMACY, LLC
Entity Type:Organization
Organization Name:KUBAT PHARMACY, LLC
Other - Org Name:KUBAT PHARMACY, INC.
Other - Org Type:Former Legal Business Name
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 1:4924 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 1:4924 CENTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3219
Practice Address - Country:US
Practice Address - Phone:402-558-8888
Practice Address - Fax:402-558-7388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERCIPIO RESPIRATORY HOLDCO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-08
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2800832OtherNCPDP
NE10025950100Medicaid
IA1326042342Medicaid
NE10025950100Medicaid
NE0414120001Medicare NSC