NPIMap

Organization Active NPI

Kubat Custom Health Care, LLC

  • Community/Retail Pharmacy
  • Omaha, NE
National Provider Identifier
1407033855
Registry record updated Jan 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
KUBAT CUSTOM HEALTH CARE, LLC
Practice address
11107 Mill Valley Rd
Omaha, NE 68154-3933
Phone
(402) 558-2474
Fax
(402) 561-1252
NPI assigned
Jan 29, 2008
Organization subpart
Yes
Parent organization
PERCIPIO KP HOLDINGS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 30, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amy TobiasNPI 1629686217
Title
Pharmacist in Charge
Phone
(402) 558-2474

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary
Compounding Pharmacy 3336C0004X
Mail Order Pharmacy 3336M0002X

Addresses

Primary practice location

11107 Mill Valley Rd
Omaha, NE 68154-3933

Mailing address

11107 Mill Valley Rd
Omaha, NE 68154-3933
Phone (402) 558-2474

Other identifiers 2

IdentifierTypeStateIssuer
47048968700MedicaidNE
2818156OtherNCPDP

Other names 2

  • Kubat HealthCare Doing business as
  • Kubat Custom Health Care, Inc. Former legal business name

National Provider Directory

National Provider Directory

Locations

4924 Center St
Ste A1
Omaha, NE 68106

11107 Mill Valley Rd
Omaha, NE 68154
Phone (402) 558-2474

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769731200000",
    "number": "1407033855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11107 MILL VALLEY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681543933",
            "telephone_number": "402-558-2474",
            "fax_number": "402-561-1252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11107 MILL VALLEY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681543933",
            "telephone_number": "402-558-2474",
            "fax_number": "402-561-1252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KUBAT CUSTOM HEALTH CARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PERCIPIO KP HOLDINGS, LLC",
        "enumeration_date": "2008-01-29",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "status": "A",
        "authorized_official_last_name": "TOBIAS",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "402-558-2474"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47048968700",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2818156",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kubat HealthCare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kubat Custom Health Care, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Kubat Custom Health Care, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.