Healthcare Provider Details

I. General information

NPI: 1902480650
Provider Name (Legal Business Name): COBORNS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 RYANS WAY
BUFFALO MN
55313-4527
US

IV. Provider business mailing address

PO BOX 6146
SAINT CLOUD MN
56302-6146
US

V. Phone/Fax

Practice location:
  • Phone: 763-330-0900
  • Fax: 855-302-4734
Mailing address:
  • Phone: 320-251-5505
  • Fax: 320-203-1095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: REBECCA PICKLER
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 320-251-5505