MEDICARE: COBORNS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies	263605	MN
3	333600000X	Pharmacy	PHAR1184	ND
4	3336C0004X	Compounding Pharmacy	1017-43	WI
5	3336C0003X	Community/Retail Pharmacy	054016420	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2127379	OTHER		PK

General Provider Information

NPI Number	:	1154622991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COBORNS INC

Provider Business Mailing Address
First Line	:	PO BOX 6146
Second Line	:	PO BOX 6146
City	:	SAINT CLOUD
State	:	MN
Zip	:	56302-6146
Country	:	US
Telephone Number	:	320-534-2745
Fax Number	:	320-203-1095

Provider Business Practice Location Address
First Line	:	1010 ENTERPRISE DR E
Second Line	:
City	:	BELLE PLAINE
State	:	MN
Zip	:	56011-2340
Country	:	US
Telephone Number	:	877-503-2605
Fax Number	:	855-459-1538

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	LYNN R YOUNG
Credential	:	RPH
Telephone Number	:	320-534-2743

Provider Enumeration Date	:	11/10/2010
Last Update Date	:	08/21/2020

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Directions to “COBORNS INC ” Practice Location

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