Healthcare Provider Details

I. General information

NPI: 1700457330
Provider Name (Legal Business Name): KUBAT HEALTH CARE OF NORFOLK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N 27TH ST STE 100
NORFOLK NE
68701-3286
US

IV. Provider business mailing address

124 N 27TH ST STE 100
NORFOLK NE
68701-3286
US

V. Phone/Fax

Practice location:
  • Phone: 531-301-6660
  • Fax: 402-371-3566
Mailing address:
  • Phone: 402-371-3444
  • Fax: 402-371-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRIAN DANIEL
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 402-315-1944