Healthcare Provider Details

I. General information

NPI: 1114077245
Provider Name (Legal Business Name): KOHLL'S PHARMACY & HOMECARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2923 LEAVENWORTH ST
OMAHA NE
68105-2739
US

IV. Provider business mailing address

12759 Q ST
OMAHA NE
68137-3211
US

V. Phone/Fax

Practice location:
  • Phone: 402-342-6547
  • Fax: 402-341-5207
Mailing address:
  • Phone: 402-895-6812
  • Fax: 402-896-7655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2234
License Number StateNE

VIII. Authorized Official

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