Provider Demographics
NPI:1558501924
Name:KOHLL'S PHARMACY & HOMECARE, INC.
Entity Type:Organization
Organization Name:KOHLL'S PHARMACY & HOMECARE, INC.
Other - Org Name:ESSENTIAL PHARMACY COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GEOFFREY
Authorized Official - Last Name:KOHLL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:402-895-6812
Mailing Address - Street 1:12759 Q ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3211
Mailing Address - Country:US
Mailing Address - Phone:402-895-6812
Mailing Address - Fax:402-895-7655
Practice Address - Street 1:620 N 114TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1571
Practice Address - Country:US
Practice Address - Phone:402-408-0012
Practice Address - Fax:402-408-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23903336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy