Healthcare Provider Details

I. General information

NPI: 1063174084
Provider Name (Legal Business Name): KUBAT PHARMACY LOUISVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 MAIN ST
LOUISVILLE NE
68037-6032
US

IV. Provider business mailing address

4924 CENTER ST
OMAHA NE
68106-3219
US

V. Phone/Fax

Practice location:
  • Phone: 402-234-3025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY SCHMID
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 531-233-4455