Provider Demographics
NPI:1154622991
Name:COBORNS INC
Entity type:Organization
Organization Name:COBORNS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:R
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:320-534-2743
Mailing Address - Street 1:PO BOX 6146
Mailing Address - Street 2:PO BOX 6146
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302-6146
Mailing Address - Country:US
Mailing Address - Phone:320-534-2745
Mailing Address - Fax:320-203-1095
Practice Address - Street 1:1010 ENTERPRISE DR E
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:MN
Practice Address - Zip Code:56011-2340
Practice Address - Country:US
Practice Address - Phone:877-503-2605
Practice Address - Fax:855-459-1538
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COBORNS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-10
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN263605332B00000X
NDPHAR1184333600000X
IL0540164203336C0003X
WI1017-433336C0004X
3336L0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1154622991Medicaid
2127379OtherPK
2127379OtherPK