Healthcare Provider Details

I. General information

NPI: 1871585133
Provider Name (Legal Business Name): KOHLLS PHARMACY & HOMECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 L ST
OMAHA NE
68117-1330
US

IV. Provider business mailing address

12759 Q ST
OMAHA NE
68137-3211
US

V. Phone/Fax

Practice location:
  • Phone: 402-733-0522
  • Fax: 402-733-8055
Mailing address:
  • Phone: 402-895-6812
  • Fax: 402-895-7655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2231
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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