Provider Demographics
NPI:1699884486
Name:COBERLY DRUG CO., INC
Entity type:Organization
Organization Name:COBERLY DRUG CO., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:COBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-663-7171
Mailing Address - Street 1:1300 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-4002
Mailing Address - Country:US
Mailing Address - Phone:620-663-7171
Mailing Address - Fax:
Practice Address - Street 1:1300 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-4002
Practice Address - Country:US
Practice Address - Phone:620-663-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KS2-081033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS007739OtherKANSAS BC/BS
KS007739OtherKANSAS BC/BS