Healthcare Provider Details

I. General information

NPI: 1154285674
Provider Name (Legal Business Name): KUBAT PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 VALLEY VIEW DR STE 16
COUNCIL BLUFFS IA
51503-5288
US

IV. Provider business mailing address

3206 S 71ST ST
OMAHA NE
68106-3507
US

V. Phone/Fax

Practice location:
  • Phone: 712-435-4040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LUNDSTROM
Title or Position: RESPIRATORY DIRECTOR
Credential:
Phone: 402-558-1192