Provider Demographics
NPI:1306099684
Name:KUBAT PHARMACY NELIGH, LLC
Entity type:Organization
Organization Name:KUBAT PHARMACY NELIGH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-350-4486
Mailing Address - Street 1:108 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NELIGH
Mailing Address - State:NE
Mailing Address - Zip Code:68756-1066
Mailing Address - Country:US
Mailing Address - Phone:402-887-5551
Mailing Address - Fax:402-887-5581
Practice Address - Street 1:108 W 11TH ST
Practice Address - Street 2:
Practice Address - City:NELIGH
Practice Address - State:NE
Practice Address - Zip Code:68756-1066
Practice Address - Country:US
Practice Address - Phone:402-887-5551
Practice Address - Fax:402-887-5581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28213336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025685700Medicaid
2117590OtherPK
6234470001Medicare NSC