Healthcare Provider Details

I. General information

NPI: 1053718528
Provider Name (Legal Business Name): KOHLLS PHARMACY & HOMECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N 27TH ST
LINCOLN NE
68503-2523
US

IV. Provider business mailing address

12759 Q ST
OMAHA NE
68137-3211
US

V. Phone/Fax

Practice location:
  • Phone: 402-476-3341
  • Fax: 402-476-3586
Mailing address:
  • Phone: 402-895-6812
  • Fax: 402-895-7655

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 Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID GEOFFREY KOHLL
Title or Position: OWNER
Credential: PHARM D
Phone: 402-895-6812