Provider Demographics
NPI:1265628259
Name:KUBAT PHARMACY, LLC
Entity type:Organization
Organization Name:KUBAT PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
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:402-315-1944
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 1:424 W 23RD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-1211
Practice Address - Country:US
Practice Address - Phone:402-727-1070
Practice Address - Fax:402-727-3982
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERCIPIO RESPIRATORY HOLDCO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-24
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
NE27853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2817558OtherNCPDP
NE10025579000Medicaid
NE100255790-00Medicaid