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NPI Code Detail

MEDICARE: KUBAT PHARMACY, LLC

MEDICARE: KUBAT PHARMACY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1720659923
Entity Type Code : Organization
Provider Name (Legal Business Name) : KUBAT PHARMACY, LLC
Provider Business Mailing Address
First Line : 3206 S 71ST ST
Second Line :
City : OMAHA
State : NE
Zip : 68106-3507
Country : US
Telephone Number : 402-558-1192
Fax Number : 402-558-0135
Provider Business Practice Location Address
First Line : 16909 LAKESIDE HILLS PLZ STE 113
Second Line :
City : OMAHA
State : NE
Zip : 68130-4652
Country : US
Telephone Number : 402-558-8888
Fax Number :
Authorized Official
Title or Position : EVP OF MEDICAL OPERATIONS
Name : BRIAN DANIEL
Credential :
Telephone Number : 402-301-1307
Provider Enumeration Date : 07/08/2021
Last Update Date : 10/31/2024

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Directions to “KUBAT PHARMACY, LLC ” Practice Location

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