Organization
COBORNS INC
Active
Parent organization
COBORNS INC
Other names
Coborn's Pharmacy #2047
Organization subpart
Yes
Provider details
NPI number
Legal business name
COBORNS INC
Authorized official
CHAD A NELLIS PHARMD (DIRECTOR OF PHARMACY)
(320) 251-5505
Entity
Organization
Contact information
Practice address
15700 88TH ST NE, OTSEGO, MN 55330
(763) 328-1701
(763) 441-3072
Mailing address
PO BOX 6146, SAINT CLOUD, MN 56302-6146
(320) 534-2745
(320) 203-1095
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578187456
—
MN
01
—
2434897
NCPDP
—
01
—
266193
STATE LICENSE
MN
Enumeration date
06/05/2020
Last updated
09/20/2023
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