Organization
COBORNS INC
Active
Parent organization
COBORNS INC
Other names
Coborn's Central Support Pharmacy #9942
Organization subpart
Yes
Provider details
NPI number
Legal business name
COBORNS INC
Authorized official
CHAD NELLIS PHARMD (DIRECTOR OF PHARMACY)
(320) 534-2743
Entity
Organization
Contact information
Practice address
110 1ST ST S STE C, SAUK RAPIDS, MN 56379-1404
(320) 202-8343
(320) 202-8341
Mailing address
PO BOX 6146, SAINT CLOUD, MN 56302-6146
(320) 534-2745
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124684634
NPI
—
01
—
2434532
NCPDP
—
Enumeration date
05/10/2019
Last updated
08/03/2022
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