Healthcare Provider Details

I. General information

NPI: 1740599893
Provider Name (Legal Business Name): KOHLL'S PHARMACY & HOMECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12741 Q ST
OMAHA NE
68137-3211
US

IV. Provider business mailing address

12741 Q ST
OMAHA NE
68137-3211
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN M KOHLL
Title or Position: OWNER
Credential: RPH
Phone: 402-108-0012