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General NPI Number Information
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NPI Number | 1003260969
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Entity Type | Organization
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Legal Business Name | COBORNS INC
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 10514 MAIN ST
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City | HAYWARD
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State | WI
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Zip | 54843-6720
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Country | US
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Telephone | 715-634-1817
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Fax | 855-304-4787
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Provider Business Mailing Address
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Address Line | PO BOX 6146 PHARMACY OFFICE
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City | SAINT CLOUD
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State | MN
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Zip | 56302-6146
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Country | US
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Telephone | 320-534-2744
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Fax | 320-203-1095
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | CHAD NELLIS
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Credential | PHARMD
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Telephone | 320-534-2743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 9403-42
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License Number State | WI
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