NPIMap

Organization Active NPI

Coborns Inc

  • Community/Retail Pharmacy
  • Hayward, WI
National Provider Identifier
1003260969
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
9403-42 Issued in WI
Legal business name
COBORNS INC
Practice address
10514 Main St
Hayward, WI 54843-6720
Phone
(715) 634-1817
Fax
(855) 304-4787
NPI assigned
Apr 18, 2016
Organization subpart
Yes
Parent organization
COBORNS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chad Nellis, PHARMD
Title
Director of Pharmacy
Phone
(320) 534-2743

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 9403-42 WI Primary
Compounding Pharmacy 3336C0004X
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

10514 Main St
Hayward, WI 54843-6720

Mailing address

PO Box 6146
Pharmacy Office
Saint Cloud, MN 56302-6146
Phone (320) 534-2744

Other identifiers 2

IdentifierTypeStateIssuer
2159610OtherPK
1000056023MedicaidWI

Other names 1

  • MARKETPLACE PHARMACY #2583 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170413001168 WI DME Supplier - PharmacyDME Supplier - Grocery Store 3072416593 Practice locations: Hayward, WI
O20170523000131 WI Part B Supplier - Mass Immunization (Roster Biller Only) 3072416593 Practice locations: Hayward, WI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D2118398Marketplace Pharmacy #258310514 S Main St, Hayward, WI 54843Certificate of waiverSep 6, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Coborns Inc10514 Main St, Hayward, WI 54843-6720(844) 800-1817 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|N… Accepts assignmentParticipating since Jan 1, 2016

National Provider Directory

National Provider Directory
Tax ID family
Coborn'S Pharmacy Service38 organizations share this tax ID, including this one
Part of
Coborn'S Pharmacy Service

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Locations

10514 Main St
Hayward, WI 54843
Phone (715) 634-1817

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753228800000",
    "number": "1003260969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6146",
            "address_2": "PHARMACY OFFICE",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563026146",
            "telephone_number": "320-534-2744",
            "fax_number": "320-203-1095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10514 MAIN ST",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548436720",
            "telephone_number": "715-634-1817",
            "fax_number": "855-304-4787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBORNS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COBORNS INC",
        "enumeration_date": "2016-04-18",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A",
        "authorized_official_last_name": "NELLIS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "320-534-2743",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "9403-42",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2159610",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000056023",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARKETPLACE PHARMACY #2583",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MARKETPLACE PHARMACY #2583",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hayward, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.