Provider Demographics
NPI:1700457330
Name:KUBAT HEALTH CARE OF NORFOLK, LLC
Entity Type:Organization
Organization Name:KUBAT HEALTH CARE OF NORFOLK, LLC
Other - Org Name:KUBAT HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-315-1944
Mailing Address - Street 1:124 N 27TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3286
Mailing Address - Country:US
Mailing Address - Phone:402-371-3444
Mailing Address - Fax:402-371-3566
Practice Address - Street 1:120 N 27TH ST STE 100
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:531-301-6660
Practice Address - Fax:402-371-3566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERCIPIO KP HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-06
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026883100Medicaid